Update on Giant Cell Arteritis: Essential Information for Ophthalmologists

Authors

  • Laura Donaldson, MD, PhD Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario

DOI:

https://doi.org/10.58931/cect.2024.3348

Abstract

Giant cell arteritis (GCA) is an important cause of irreversible vision loss in the elderly population. For any physician, making this diagnosis can be difficult due to the highly variable clinical presentation of this large-vessel vasculitis. The 1990 American College of Rheumatology (ACR) classification criteria for GCA are frequently used, however, they were developed to classify GCA patients vs those with other forms of vasculitis and are not true diagnostic criteria. Despite the high predilection of GCA for ocular circulations, the original 1990 criteria did not include any signs or symptoms related to vision. The classification criteria were updated by the ACR and European Alliance of Associations for Rheumatology (EULAR) in 2022 with the significant inclusion of “Sudden vision loss” (Table 1).

Author Biography

Laura Donaldson, MD, PhD, Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario

Dr. Donaldson is a graduate of the MD/PhD program at the University of Toronto. She completed ophthalmology residency at McMaster University and neuro-ophthalmology fellowship at the University of Toronto. She is currently practicing neuro‑ophthalmology and general ophthalmology in Niagara Falls and Hamilton and maintains interests in teaching and research.

References

Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122-8. DOI: https://doi.org/10.1002/art.1780330810

Ponte C, Grayson PC, Robson JC, et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis. 2022;81(12):1647-53. DOI: https://doi.org/10.1136/ard-2022-223480

Hayreh SS, Podhajsky PA, Zimmerman B. Occult giant cell arteritis: Ocular manifestations. Am J Ophthalmol. 1998;125(4):521-6. DOI: https://doi.org/10.1016/S0002-9394(99)80193-7

Issa M, Donaldson L, Jeeva-Patel T, et al. Ischemic ocular manifestations of giant cell arteritis: A Canadian case series. May 15:436:120222 DOI: https://doi.org/10.1016/j.jns.2022.120222

Chen JJ, Leavitt JA, Fang C, et al. Evaluating the incidence of arteritic ischemic optic neuropathy and other causes of vision loss from giant cell arteritis. Ophthalmology. 2016;123(9):1999-2003. DOI: https://doi.org/10.1016/j.ophtha.2016.05.008

Singh AG, Kermani TA, Crowson CS, et al. Visual manifestations in giant cell arteritis: Trend over 5 decades in a population-based cohort. J Rheumatol. 2015;42(2):309-15. DOI: https://doi.org/10.3899/jrheum.140188

Hayreh SS. Posterior ischaemic optic neuropathy: Clinical features, pathogenesis, and management. Eye. 2004;18(11):1188-1206. DOI: https://doi.org/10.1038/sj.eye.6701562

González-Gay MA, García-Porrúa C, Llorca J, et al. Visual manifestations of giant cell arteritis: Trends and clinical spectrum in 161 patients. Medicine. 2000;79(5):283-92. DOI: https://doi.org/10.1097/00005792-200009000-00001

Dumont A, Lecannuet A, Boutemy J, et al. Characteristics and outcomes of patients with ophthalmologic involvement in giant-cell arteritis: A case-control study. Semin Arthritis Rheum. 2020;50(2):335-41. DOI: https://doi.org/10.1016/j.semarthrit.2019.09.008

Hayreh SS, Bridget Zimmerman M. Amaurosis fugax in ocular vascular occlusive disorders: Prevalence and pathogeneses. Retina. 2014;34(1):1115-22. DOI: https://doi.org/10.1097/IAE.0b013e31829234b5

Donaldson L, Freund P, Aslahi R, et al. Dialysis-associated nonarteritic anterior ischemic optic neuropathy: a case series and review. J Neuroophthalmol. 2022;42(1):e116-23. DOI: https://doi.org/10.1097/WNO.0000000000001493

Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998;125(4):509-20. DOI: https://doi.org/10.1016/S0002-9394(99)80192-5

Saito H, Tomidokoro A, Tomita G, et al. Optic disc and peripapillary morphology in unilateral nonarteritic anterior ischemic optic neuropathy and age- and refraction-matched normals. Ophthalmology. 2008;115(9):1585-90. DOI: https://doi.org/10.1016/j.ophtha.2008.01.012

Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy: IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology. 1987;94(11):1503-8. DOI: https://doi.org/10.1016/S0161-6420(87)33263-4

Hayreh SS. Anterior ischaemic optic neuropathy differentiation of arteritic from non-arteritic type and its management. Eye (Basingstoke). 1990;4(1):25-41. DOI: https://doi.org/10.1038/eye.1990.4

Hayreh S. Central retinal artery occlusion. Indian J Ophthalmol. 2018;66(12):1684-94. DOI: https://doi.org/10.4103/ijo.IJO_1446_18

Hayreh S. Posterior ischemic optic neuropathy. Ophthalmologica. 1981;182:29-41. DOI: https://doi.org/10.1159/000309085

Melberg NS, Grand MG, Dieckert JP, et al. Cotton-wool spots and the early diagnosis of giant cell arteritis. Ophthalmology. 1995;102(11):1611-4. DOI: https://doi.org/10.1016/S0161-6420(95)30820-2

Kasimov M, Popovic MM, Micieli JA. Paracentral acute middle maculopathy associated with anterior ischemic optic neuropathy and cilioretinal artery occlusion in giant cell arteritis. J Neuroophthalmol. 2022;42(1):e437-9. DOI: https://doi.org/10.1097/WNO.0000000000001306

Purvin VA, Kawasaki A, Jacobson DM. Optic perineuritis: clinical and radiographic features. Arch Ophthalmol. 2001;119(9):1299-306. DOI: https://doi.org/10.1001/archopht.119.9.1299

Emami S, Howarth D, Margolin E. Giant cell arteritis presenting as bilateral optic perineuritis in an African man. J Neuroophthalmol. 2021;41(2):e149-52.. DOI: https://doi.org/10.1097/WNO.0000000000000951

Ing EB, Miller NR, Ten Hove M, et al. Diplopia and giant cell arteritis. J Neuroophthalmol. 2019;39(4):546-7. DOI: https://doi.org/10.1097/WNO.0000000000000847

Chazal T, Sene T, Clavel Refregiers G, et al. POS0808 characteristics and prognosis of binocular diplopia in patients with giant cell arteritis. Ann Rheum Dis. 2022;81(Suppl 1):693.2-694. DOI: https://doi.org/10.1136/annrheumdis-2022-eular.3527

Ing E, Xu Q, Chuo J, et al. Practice preferences: temporal artery biopsy versus doppler ultrasound in the work-up of giant cell arteritis. Neuro-Ophthalmology. 2020;44(3):174-81. DOI: https://doi.org/10.1080/01658107.2019.1656752

Micieli JA, Grossniklaus HE, Peragallo JH. Masquerades of giant cell arteritis evident on temporal artery biopsy. J Clin Rheumatol. 2021;27(8):e568-74. DOI: https://doi.org/10.1097/RHU.0000000000001072

Niederkohr RD, Levin LA. A Bayesian analysis of the true sensitivity of a temporal artery biopsy. Invest Ophthalmol Vis Sci. 2007;48(2):675-80. DOI: https://doi.org/10.1167/iovs.06-1106

Rubenstein E, Maldini C, Gonzalez-Chiappe S, Chevret S, Mahr A. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: A systematic literature review and meta-analysis. Rheumatology (Oxford). 2020;59(5):1011-20. DOI: https://doi.org/10.1093/rheumatology/kez385

Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Rheumatol. 2021;73(8):1349-65. DOI: https://doi.org/10.1002/art.41774

Dejaco C, Ramiro S, Bond M, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis. 2024 May 15;83(6):741-51

Luqmani R, Lee E, Singh S, et al. The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis (TABUL): A diagnostic accuracy and cost-effectiveness study. Health Technol Assess (Rockv). 2016;20(90):1-238. DOI: https://doi.org/10.3310/hta20900

Bosch P, Bond M, Dejaco C, et al. Imaging in diagnosis, monitoring and outcome prediction of large vessel vasculitis: a systematic literature review and meta-analysis informing the 2023 update of the EULAR recommendations. RMD Open. 2023;9(3): e003379. DOI: https://doi.org/10.1136/rmdopen-2023-003379

Santoro L, D’Onofrio F, Bernardi S, et al A. Temporal ultrasonography findings in temporal arteritis: Early disappearance of halo sign after only 2 days of steroid treatment. Rheumatology (Oxford). 2013;52(4):622. DOI: https://doi.org/10.1093/rheumatology/kes387

Junek ML, Riaz S, Garner S, et al. Added diagnostic yield of temporal artery magnetic resonance angiography in the evaluation of giant cell arteritis. Rheumatology (Oxford). 2023;62(6):2197-2202. DOI: https://doi.org/10.1093/rheumatology/keac583

Monti S, Águeda AF, Luqmani RA, et al. Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: Focus on giant cell arteritis. RMD Open. 2019;5(2):e001003. DOI: https://doi.org/10.1136/rmdopen-2019-001003

Hauenstein C, Reinhard M, Geiger J, et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology (Oxford). 2012;51(11):1999-2003. DOI: https://doi.org/10.1093/rheumatology/kes153

Bruce GM. Temporal arteritis as a cause of blindness; review of literature and report of a case. Trans Am Ophthalmol Soc. 1949;47:300-16.

González-Gay MA, Blanco R, Rodríguez-Valverde V, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: Predictors and response to treatment. Arthritis Rheum. 1998;41(8):1497-504. DOI: https://doi.org/10.1002/1529-0131(199808)41:8<1497::AID-ART22>3.0.CO;2-Z

Hemmig AK, Aschwanden M, Seiler S, et al. Long delay from symptom onset to first consultation contributes to permanent vision loss in patients with giant cell arteritis: a cohort study. RMD Open. 2023;9(1):e002866. DOI: https://doi.org/10.1136/rmdopen-2022-002866

Singh AG, Crowson CS, Kermani TA, et al. Visual manifestations in giant cell arteritis: Trend over five decades. Arthritis Rheum. 2012;64.

Liozon E, Dalmay F, Lalloue F, et al. Risk factors for permanent visual loss in biopsy-proven giant cell arteritis: A study of 339 patients. J Rheumatol. 2016;43(7):1393-9. DOI: https://doi.org/10.3899/jrheum.151135

Kokloni IN, Aligianni SI, Makri O, et al. Vision loss in giant cell arteritis: case-based review. Rheumatol Int. 2022;42(10):1855-62. DOI: https://doi.org/10.1007/s00296-022-05160-x

Hayreh SS, Zimmerman B. Visual deterioration in giant cell arteritis patients while on high doses of corticosteroid therapy. Ophthalmology. 2003;110(6):1204-15. DOI: https://doi.org/10.1016/S0161-6420(03)00228-8

Kanakamedala A, Hussain M, Kini A, et al. Corticosteroid usage in giant cell arteritis. Neuroophthalmology. 2021;45(1):17-22. DOI: https://doi.org/10.1080/01658107.2020.1767656

Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020;79(1):19-30. DOI: https://doi.org/10.1136/annrheumdis-2019-215672

Hayreh SS, Zimmerman B, Kardon RH. Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature. Acta Ophthalmol Scand. 2002;80(4):355-67. DOI: https://doi.org/10.1034/j.1600-0420.2002.800403.x

Stone JH, Tuckwell K, Dimonaco S, et al. Trial of tocilizumab in giant-cell arteritis. N Engl J Med. 2017;377(4). DOI: https://doi.org/10.1056/NEJMoa1613849

Downloads

Published

2024-08-30

How to Cite

1.
Donaldson L. Update on Giant Cell Arteritis: Essential Information for Ophthalmologists. Can Eye Care Today [Internet]. 2024 Aug. 30 [cited 2024 Nov. 16];3(3):19–24. Available from: https://canadianeyecaretoday.com/article/view/3-3-donaldson

Issue

Section

Articles