title: The erythrocyte sedimentation rate is associated with the development of visual complications in biopsy-proven giant cell arteritis.
abstract: 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.
authors.affiliation: Division of Rheumatology, Lugo, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Lopez-Diaz
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez-Juanatey
authors.forename: Jose L
authors.initials: JL
authors.lastname: Peña-Sagredo
authors.forename: Javier
authors.initials: J
authors.lastname: Martin
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gonzalez-Gay
mesh_terms: 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
chemical_list: D000418:Albumins; D005938:Glucocorticoids; D002097:C-Reactive Protein; D000469:Alkaline Phosphatase