FRI0494 Spectrum of visual involvement in giant cell arteritis
Authors: F. Laskou, T. Aung, D. Gayford, S. Banerjee, C.S. Crowson, E.L. Matteson, B. Dasgupta
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The dreaded complication of giant cell arteritis (GCA), irreversible sight loss (SL), is present in 15%–25% of patients at diagnosis. This is likely due to delayed presentation, recognition and treatment. Fast track pathways for urgent assessment of suspected GCA reduce SL with associated cost savings. Information regarding the burden of SL in GCA is required to guide health strategy and has been explored in this UK wide study. <h3>Methods</h3> This is a prospective observational multi-centre study of visual involvement attributable to GCA. Demographic, disease features and treatment information was collected on all patients with new or relapsing GCA with or without visual symptoms (VS) or SL.SL was defined as symptomatic loss of acuity, field of vision or diplopia ascribable to ischaemic complications of GCA. Patients with transient VS were not considered to have SL. Analyses were performed using chi-squared and rank sum tests. <h3>Results</h3> Patients were predominantly female (274/388) and Caucasian; 3 non-Caucasian(Asian British, Black/Afro-Caribbean and Turkish).VS were present in 135/388 patients (35%) from 19 UK sites. Of patients with VS, these were transient or intermittent SL (n=9,7%), diplopia (n=33,24%), blurred vision (n=17,13%), flashing lights (n=4,3%) and eye pain (n=7,5%). Transient or permanent loss of acuity occurred in 92 patients (48 anterior ischaemic optic neuropathy [AION], 6 central retinal artery occlusion [CRAO],1 posterior ischaemic optic neuropathy, all attributed to GCA);1 hemispheric retinal vein occlusion, 1 branch retinal artery occlusion, 1 peri-papillary haemorrhage, 1 vitelliform dystrophy macula.8 had oculomotor nerve palsies(NP)(1 bilateral 3rd,1 bilateral 6th and 6 unilateral 3rd or 6th NP). Patients with VS were older than those without(mean ±SD age 75.9±9.3 and 73.5±8.5 respectively, p&lt;0.001). Patients with VS had less headaches (p=0.012) and scalp tenderness (p=0.05) but more frequently tongue claudication (p=0.014), shorter symptom duration (3.9±5.5 days, p=0.001), lower CRP although not statistically significant(p=0.059), were less likely to meet ACR criteria and to improve than those without VS (p&lt;0.001). No association was found with comorbidities or deprivation index.SL in 54 (40%) patients was due to AION or CRAO. Transient CRAO or AION was described in 17 and 30/47 (64%) had permanent SL (data missing from 7 patients). Patients with AION/CRAO were older (80.9±6.7 years) than those without AION/CRAO (73.3±8.7 years, p&lt;0.001). They had shorter symptom duration (4.2±7.0 days, p=0.024), less likely to improve than those without AION/CRAO (p&lt;0.001), less likely to have headaches (p&lt;0.001) or polymyalgic symptoms (p=0.002), and more likely to have jaw claudication (p=0.043) and hypertension (p=0.002). Only 7 had diplopia on presentation. 5 patients experienced AION as manifestation of recrudescing disease. <h3>Conclusions</h3> VS often leading to SL in GCA requires urgent management. Patients with VS were older, without 'typical symptoms' such as headache and polymyalgia but more likely to have ischaemic symptoms such as jaw and tongue pain and hypertension. Recognition of VS associated features should be embodied in public and professional awareness programs to prevent permanent SL in GCA. <h3>Disclosure of Interest</h3> None declared