title: Visual manifestations in giant cell arteritis: trend over 5 decades in a population-based cohort.
abstract: OBJECTIVE
  To evaluate clinical characteristics, treatment, and outcomes of patients with visual changes from giant cell arteritis (GCA) and to examine trends over the last 5 decades.
  
  
  METHODS
  We reviewed the medical records of a population-based cohort of patients with GCA diagnosed between 1950 and 2004. The clinical, ophthalmological, and laboratory features of patients with visual manifestations attributable to GCA were compared to patients without visual complications. Trends over time were examined using logistic regression modeling adjusted for age and sex.
  
  
  RESULTS
  In a cohort of 204 cases of GCA (mean age 76.0 ± 8.2 yrs, 80% female), visual changes from GCA were observed in 47 patients (23%), and 4.4% suffered complete vision loss. A higher proportion of patients with visual manifestations reported jaw claudication than did patients without visual changes (55% vs 38%, p = 0.04). Over a period of 55 years, we observed a significant decline in the incidence of visual symptoms due to GCA. There was a lower incidence of ischemic optic neuropathy in the 1980-2004 cohort vs 1950-1979 (6% vs 15%, p = 0.03). Patients diagnosed in later decades were more likely to recover from visual symptoms (HR 1.34, 95% CI 1.06-1.71). Chances of recovery were poor in patients with anterior ischemic optic neuropathy or complete vision loss.
  
  
  CONCLUSIONS
  Incidence of visual symptoms has declined over the past 5 decades, and chances of recovery from visual symptoms have improved. However, complete loss of vision is essentially irreversible. Jaw claudication is associated with higher likelihood of development of visual symptoms.
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic.
authors.forename: Abha G
authors.initials: AG
authors.lastname: Singh
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic.
authors.forename: Tanaz A
authors.initials: TA
authors.lastname: Kermani
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic.
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Weyand
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: From the Division of Rheumatology, Mayo Clinic, Rochester, Minnesota; Division of Rheumatology, University of California, Los Angeles; Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.A.G. Singh, MBBS, Division of Rheumatology, Mayo Clinic; T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; C.S. Crowson, MS, Division of Rheumatology, Mayo Clinic; C.M. Weyand, MD, PhD, Division of Immunology and Rheumatology, Stanford University School of Medicine; E.L. Matteson, MD, MPH; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic. warrington.kenneth@mayo.edu.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014786:Vision Disorders / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: BLINDNESS; GIANT CELL ARTERITIS; STEROIDS; VASCULITIS; VISION LOSS; VISUAL MANIFESTATIONS