title: Visual Complications in Patients with Biopsy-proven Giant Cell Arteritis: A Population-based Study.
abstract: To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population.
  
  
  
  Data from 840 patients with GCA in the county of Skåne, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population.
  
  
  
  There were 85 patients (10%) who developed ≥ 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (± 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of β-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3-3.8).
  
  
  
  Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with β-adrenergic inhibitors compared with patients without visual complications.
authors.affiliation: From the Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg; Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; Department of Clinical Sciences, Orthopaedics and Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.M. Saleh, MD, Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital; C. Turesson, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; M. Englund, MD, PhD, Department of Clinical Sciences, Orthopaedics, Lund University, and the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania; A.J. Mohammad, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, and the Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
authors.forename: Muna
authors.initials: M
authors.lastname: Saleh
authors.affiliation: From the Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg; Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; Department of Clinical Sciences, Orthopaedics and Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.M. Saleh, MD, Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital; C. Turesson, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; M. Englund, MD, PhD, Department of Clinical Sciences, Orthopaedics, Lund University, and the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania; A.J. Mohammad, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, and the Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
authors.forename: Carl
authors.initials: C
authors.lastname: Turesson
authors.affiliation: From the Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg; Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; Department of Clinical Sciences, Orthopaedics and Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.M. Saleh, MD, Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital; C. Turesson, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; M. Englund, MD, PhD, Department of Clinical Sciences, Orthopaedics, Lund University, and the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania; A.J. Mohammad, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, and the Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
authors.forename: Martin
authors.initials: M
authors.lastname: Englund
authors.affiliation: From the Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg; Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; Department of Clinical Sciences, Orthopaedics and Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.M. Saleh, MD, Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital; C. Turesson, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; M. Englund, MD, PhD, Department of Clinical Sciences, Orthopaedics, Lund University, and the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania; A.J. Mohammad, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, and the Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
authors.affiliation: From the Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg; Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; Department of Clinical Sciences, Orthopaedics and Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.M. Saleh, MD, Department of Internal Medicine, Section of Rheumatology, Helsingborg Hospital; C. Turesson, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Malmö, Rheumatology, Malmö; M. Englund, MD, PhD, Department of Clinical Sciences, Orthopaedics, Lund University, and the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania; A.J. Mohammad, MD, PhD, Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Rheumatology, Lund, and the Vasculitis and Lupus Clinic, Addenbrooke's Hospital. Aladdin.mohammad@med.lu.se.
authors.forename: Aladdin J
authors.initials: AJ
authors.lastname: Mohammad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D013700:Giant Cell Arteritis / Q000097:blood / Q000150:complications* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014786:Vision Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology
chemical_list: D002097:C-Reactive Protein
keywords: CLINICAL CHARACTERISTICS; GIANT CELL ARTERITIS; INFLAMMATION; RATE RATIO; VISUAL COMPLICATIONS; β-BLOCKERS