Giant Cell Arteritis

INTRODUCTION:

Giant cell arteritis (GCA) is an OPHTHALMIC EMERGENCY, because it carries a high risk of severe visual loss in one or both eyes - loss which is usually PREVENTABLE. Early diagnosis is the key to correct management and prevention of visual loss. GCA is also well-known for masquerading as other diseases.

We have conducted the following GCA related studies on patients seen in our Ocular Vascular Clinic, over the past three decades:

1. In 363 patients, who had temporal artery biopsy done in our department for suspected GCA, we assessed the validity, reliability, sensitivity, and specificity of the signs and symptoms of and diagnostic tests for GCA.¹
2. In 170 patients with positive temporal artery biopsy for GCA, we studied the ophthalmic manifestations of GCA.²
3. In 85 patients with visual symptoms due to GCA, we investigated the incidence of occult giant cell arteritis (i.e. GCA not associated with any systemic symptoms).³
4. In 84 patients (114 eyes) with visual loss, we investigated the incidence and extent of visual improvement achieved by high-dose steroid therapy.⁴
5. In 144 patients (271 eyes), we investigated the incidence and extent of visual deterioration while taking high doses of corticosteroid.⁵
6. In 101 GCA patients and 218 patients with non-arteritic anterior ischemic optic neuropathy (AION), we investigated the usefulness of thrombocytosis and other hematologic tests in diagnosis of GCA and differentiation of arteritic AION from non-arteritic AION.⁶
7. In 145 patients whose GCA was confirmed by temporal artery biopsy, we investigated various aspects of corticosteroid therapy in the management of GCA in a 27-year planned study.⁷

These studies revealed much valuable information on GCA, which is helpful in its early diagnosis and management. They also showed that the controversy on diagnostic criteria and management of GCA is caused by the very different perspectives of GCA of rheumatologists and ophthalmologists^7,8 - rheumatologists essentially deal with patients with rheumatologic symptoms, while ophthalmologists see GCA patients with the far more serious manifestation of visual loss, or patients who lose vision without having any rheumatologic or other systemic symptoms at all – i.e., occult GCA.³ Following is a brief summary of the information provided by our studies and relevant information from a review of the literature.⁷

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