title: Risk Factors for Permanent Visual Loss in Biopsy-proven Giant Cell Arteritis: A Study of 339 Patients.
abstract: To determine the risk factors for permanent visual loss (PVL) in patients with biopsy-proven giant cell arteritis (GCA) and the usefulness of the factors in clinical practice.
  
  
  
  From 1976 through 2015, the clinical charts and laboratory results of 339 patients with biopsy-proven GCA were recorded prospectively at the time of diagnosis. We used multivariable logistic regression analysis to determine which of 24 pretreatment characteristics were associated with PVL.
  
  
  
  Visual ischemic manifestations occurred in 108 patients, including PVL in 53 (16%), bilaterally in 15 patients (28%). The independent predictors associated with an increased risk of PVL were age (OR 1.06, 95% CI 1.01-1.12, p = 0.01), a history of transient visual ischemic symptoms (OR 2.62, 95% CI 1.29-5.29, p < 0.01), and jaw claudication (OR 2.11, 95% CI 1.09-4.10, p = 0.03). The presence of fever (OR 0.30, 95% CI 0.14-0.64, p < 0.01) and rheumatic symptoms (OR 0.23, 95% CI 0.10-0.57, p = 0.001) were associated with a markedly reduced risk of developing visual loss (3.7% if features were both present). No laboratory variables were independently associated with PVL.
  
  
  
  The visual ischemic risk of untreated GCA can be readily estimated upon simple clinical findings, but not laboratory variables. However, we did not identify a subgroup of patients carrying no risk of developing visual loss. Glucocorticoid treatment remains, therefore, urgent for any patient with a high clinical suspicion index.
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges. liozone@yahoo.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Liozon
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: François
authors.initials: F
authors.lastname: Dalmay
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lalloue
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gondran
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: Holy
authors.initials: H
authors.lastname: Bezanahary
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Fauchais
authors.affiliation: From the Department of Internal Medicine, Le centre hospitalier et universitaire (CHU) Limoges, Limoges, France.E. Liozon, MD, Department of Internal Medicine, CHU Limoges; F. Dalmay, PhD, Department of Internal Medicine, CHU Limoges; F. Lalloue, PhD, Department of Internal Medicine, CHU Limoges; G. Gondran, MD, Department of Internal Medicine, CHU Limoges; H. Bezanahary, MD, Department of Internal Medicine, CHU Limoges; A.L. Fauchais, MD, PhD, Department of Internal Medicine, CHU Limoges; K.H. Ly, MD, PhD, Department of Internal Medicine, CHU Limoges.
authors.forename: Kim-Heang
authors.initials: KH
authors.lastname: Ly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology* / Q000473:pathology; D005123:Eye / Q000098:blood supply*; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: GIANT CELL ARTERITIS; POLYMYALGIA RHEUMATICA; RISK FACTORS; VISUAL LOSS