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Stroke common in GCA patients with ophthalmic ischaemic symptoms

11 Mar 2017

Patients with giant cell arteritis (GCA) who experience recent ophthalmic ischaemic symptoms and exhibit low inflammatory variables are at risk of stroke, particularly in the vertebrobasilar territory, suggests a recent study.

Researchers created two retrospective multicenter cohorts for this study. One group included patients with GCA diagnosed according to the American College of Rheumatology criteria between 1995 and 2015, and stroke occurring at the time of GCA diagnosis or occurring within 4 weeks of starting GCA therapy. The other group consisting of GCA patients without stroke served as controls.

A total of 40 patients (median age, 78 years; 53 percent female) with GCA-related stroke were included and compared with 200 control patients.

There were 29 patients (73 percent) who had stroke at GCA diagnosis, while 11 patients had stroke after GCA diagnosis. Stroke occurred in the vertebrobasilar territory in 29 patients (73 percent). Seven patients died within a few hours or days following stroke.

Compared with patients in the control group, stroke patients had more ophthalmic ischaemic symptoms (63 vs 25 percent; p<0.001) but lower biological inflammatory variables (C-reactive protein: 61 vs 99 mg/l; p=0.04) and less anaemia (59 vs 79 percent; p=0.03).

The presence of ophthalmic ischaemic symptoms at diagnosis (odds ratio [OR], 5; 95 percent CI, 2.14 to 12.33; p=0.0002) and the absence of anaemia (OR, 0.39; 0.16 to 0.99; p=0.04) were the strongest predictors for the occurrence of stroke, based on multivariate logistic regression.

These findings are similar to an earlier study, which found that GCA-related stroke essentially affects the vertebrobasilar territory and mainly occurs in old men with associated vascular risk factors. [J Neurol Neurosurg Psychiatry 2015;86:216-21]

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