The erythrocyte sedimentation rate is associated with the development of visual complications in biopsy-proven giant cell arteritis.
OBJECTIVE
To investigate the potential association between levels of the erythrocyte sedimentation rate (ESR) and specific clinical features of giant cell arteritis (GCA), in particular, visual loss, in a series of consecutive patients diagnosed with GCA at the reference hospital for a well-defined population.


METHODS
The case records of all biopsy-proven GCA patients diagnosed at the Department of Medicine of Hospital Xeral-Calde (Lugo, Northwest Spain) between 1981 and 2006 were reviewed. Clinical information and laboratory data including ESR at the time of disease diagnosis were assessed.


RESULTS
Only 10 (3.6%) of the 273 patients had ESR <50 mm/h. Significant differences in the frequency of visual ischemic complications according to different levels of ESR were observed (P = 0.01), mainly due to an increased frequency of visual ischemic events in patients with ESR between 70 and 100/h at the time of disease diagnosis. Twenty-five (21%) of 120 individuals with ESR values ranging between 70 and 100 mm/h experienced permanent visual loss compared with only 10 (7%) of the remaining 153 patients (P = 0.0005; OR: 3.76 [95% CI: 1.73-8.19]). An ESR between 70 and 100 mm/h was the best predictor of visual ischemic complications (OR = 2.29 [95% CI: 1.16-4.55]; P = 0.03) and irreversible visual loss (OR = 3.58 [95% CI: 1.51-8.49]; P = 0.004).


CONCLUSIONS
The results from this study show an increased risk of severe ocular complications in biopsy-proven GCA patients presenting with an ESR between 70 and 100 mm/h. Prompt initiation of corticosteroid therapy and close follow-up of these patients is recommended to minimize the risk of irreversible visual loss.
Lopez-Diaz
Maria J
MJ
Division of Rheumatology, Lugo, Spain.
Llorca
Javier
J
Gonzalez-Juanatey
Carlos
C
Peña-Sagredo
Jose L
JL
Martin
Javier
J
Gonzalez-Gay
Miguel A
MA
D000418:Albumins / Q000032:analysis; D000469:Alkaline Phosphatase / Q000097:blood; D001707:Biopsy, Needle; D001766:Blindness / Q000209:etiology*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D013700:Giant Cell Arteritis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007958:Leukocyte Count; D008297:Male; D010976:Platelet Count
D000418:Albumins; D005938:Glucocorticoids; D002097:C-Reactive Protein; D000469:Alkaline Phosphatase