POS0791 A NATIONWIDE STUDY OF OCULAR MANIFESTATIONS AMONG HOSPITALIZED PATIENTS WITH GIANT CELL ARTERITIS

Abstract

BackgroundOcular manifestations are common among patients with giant cell arteritis (GCA). Most feared is a permanent visual impairment reported in up to 15-20% of GCA patients1. Estimates of ocular manifestations vary significantly between studies, and large, nationwide studies are currently lacking. In GCA, visual impairment has been associated with high and low inflammatory markers2. Also, low-dose aspirin treatment has been associated with a reduced risk of visual impairment in patients with GCA3, but the evidence remains sparse.ObjectivesTo investigate the risk of ocular manifestations among hospitalized patients with GCA. Furthermore, to investigate the association between inflammatory marker levels and low-dose aspirin treatment with the risk of ocular manifestations.MethodsA Danish, nationwide, register-based cohort study including 14,574 incident GCA patients diagnosed between 1996 and 2018, and 145,740 general population referents, matched on age, sex, and calendar time. Ocular manifestations were defined as retinal vascular occlusions, disorders of opticus, visual impairment, diplopia, and amaurosis fugax. We tabulated characteristics of the GCA and reference cohort at the time of diagnosis including ocular manifestations recorded within one year of the GCA diagnosis. Regression analyses for incident ocular manifestations were performed using a pseudo-observational approach with the index date defined as the date of the GCA diagnosis. Cumulative incidence proportions (CIPs) and relative risks (RRs) of incident ocular manifestations with 95% confidence intervals (CIs) were calculated with death as a competing risk.ResultsWithin one year of the diagnosis, 1,026/14,574 (7%) of GCA patients were registered with ocular manifestations with 392/1,026 (38%) being prior to and 634/1,026 (62%) after the GCA diagnosis, and 744/1,026 (73%) were registered within one month of the diagnosis. A total of 336/1,026 (33%) were retinal vascular occlusions, 300/1,026 (29%) disorders of the opticus nerve, 177/1,026 (17%) visual impairment, 90/1,026 (9%) diplopia, and 123/1,026 (12%) amaurosis fugax. The CIP of ocular manifestations among GCA patients was 4.0% (95% CI: 3.6-4.3), 4.2% (95% CI: 3.9-4.6), and 4.6% (95% CI: 4.2-4.9) after 3, 6, and 12 months following the diagnosis with a 1-year RR of 28.0 (95% CI: 24.0-32.7) compared to the general population. Age above 70 years, male sex, and a positive temporal artery biopsy were associated with an increased 1-year RR of incident ocular manifestations. Neither treatment with low-dose aspirin nor baseline CRP nor ESR levels was related to the risk of ocular manifestations.ConclusionIn GCA, most cases of ocular manifestations occur at the time of diagnosis with over one-third of cases occurring prior to the diagnosis, emphasizing the need for early recognition and treatment. Low-dose aspirin treatment was not associated with a reduced risk of ocular manifestations among patients with GCA.