PERMANENT VISUAL-LOSS AND CEREBROVASCULAR ACCIDENTS IN GIANT-CELL ARTERITIS - PREDICTORS AND RESPONSE TO TREATMENT

Objective. To assess the features and therapeutic response of visual m anifestations and cerebrovascular accidents (CVA) in giant cell (tempo ral) arteritis (GCA) and to identify the predictors for permanent visu al loss (VL) and CVA in GCA. Methods. Two hundred thirty-nine patients with biopsy-proven GCA were included in a retrospective multicenter s tudy. Data on demographic, clinical, and laboratory features were coll ected. The predictors were identified by a forward stepwise nonconditi onal logistic regression analysis. Results. Visual involvement was obs erved in 69 patients, and 34 had permanent VL. The diagnostic delay si nce the onset of visual symptoms was longer in the 11 patients with bi lateral VL. The interval to involvement of the second eye was 5 days. The predictors of permanent VL were transient VL, jaw claudication, no rmal levels of liver enzymes, and absence of constitutional syndrome. Partial improvement of visual acuity was observed in 8 patients. After adjustment for the treatment regimen (intravenous pulse methylprednis olone versus oral prednisone), early treatment (within the first day o f VL) was the only predictor of improvement; CVA, observed in 8 patien ts, involved the vertebral-basilar territory in 4, CVA was more freque nt in patients,vith visual symptoms, appearing shortly after VL (media n 7 days) and despite appropriate therapy. Predictors of CVA were perm anent VL and jaw claudication. Conclusion. In GCA, the risk of permane nt VL is increased in patients with transient VL and/or jaw claudicati on, and decreased in those with elevated liver enzyme levels and/or co nstitutional syndrome. Partial therapeutic success is more probable if treatment is started within the first day of VL, CVA is more likely i n patients with permanent VL and/or jaw claudication, often developing despite appropriate corticosteroid therapy.