Visual loss and other cranial ischaemic complications in giant cell arteritis

被引:124
作者
Soriano, Alessandra [1 ,2 ]
Muratore, Francesco [1 ,3 ]
Pipitone, Nicolo [1 ]
Boiardi, Luigi [1 ]
Cimino, Luca [4 ]
Salvarani, Carlo [1 ,3 ]
机构
[1] Ist Ricovero & Cura Carattere Sci Reggio Emilia, Azienda Osped, Div Rheumatol, Viale Risorgimento 80, I-42100 Reggio Emilia, Italy
[2] Univ Rome, Campus Biomed, Via Alvaro del Portillo 200, I-00128 Rome, Italy
[3] Univ Modena & Reggio Emilia, Via Univ 4, I-41121 Modena, Italy
[4] Ist Ricovero & Cura Carattere Sci Reggio Emilia, Div Ophthalmol, Azienda Osped, Viale Risorgimento 80, I-42100 Reggio Emilia, Italy
关键词
POPULATION-BASED COHORT; TEMPORAL ARTERITIS; RISK-FACTORS; DOUBLE-BLIND; POLYMYALGIA-RHEUMATICA; CLINICAL-MANIFESTATIONS; CARDIOVASCULAR-DISEASE; ANGIOGENIC ACTIVITY; CONTROLLED-TRIAL; GROWTH-FACTOR;
D O I
10.1038/nrrheum.2017.98
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Giant cell arteritis (GCA) is the most common form of vasculitis in individuals aged 50 years and over. GCA typically affects large and medium-sized arteries, with a predilection for the extracranial branches of the carotid artery. Patients with GCA usually present with symptoms and signs that are directly related to the artery that is affected, with or without constitutional manifestations. The most dreaded complication of GCA is visual loss, which affects about one in six patients and is typically caused by arteritis of the ophthalmic branches of the internal carotid artery. Before the advent of glucocorticoid treatment, the prevalence of visual complications was high. Increasing awareness by physicians of the symptoms of GCA and advances in diagnostic techniques over the past twenty years have also contributed to a substantial decline in the frequency of permanent visual loss. Ischaemic brain lesions are less common than visual lesions, and mostly result from vasculitis of the extradural vertebral or carotid arteries. In the case of both the eye and the brain, ischaemic damage is thought to result from arterial stenosis or occlusion that occurs secondary to the inflammatory process. The inflammatory response at the onset of arteritis, its role as a predictor of complications and the role of traditional cardiovascular risk factors have been extensively investigated in the past decade. In this Review, the epidemiology, risk factors, clinical presentation and current therapeutic approach of GCA-related ischaemic events are discussed, with a particular emphasis on visual loss.
引用
收藏
页码:476 / 484
页数:9
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