Ophthalmic Giant Cell Arteritis and the Risk of Stroke Save

Chronic inflammation is a well-known risk factor for cardiovascular disease and stroke. In the last year, we have reported that autoimmune disease (http://buff.ly/2lTXA8w) and herpes zoster infection (http://buff.ly/2lUjsAv) may contribute to an increased risk for cerebrovascular accidents (CVA).

The Journal of Rheumatology has reported the results of a cohort study demonstrating that CVA is more likely in giant cell arteritis (GCA) patients who have ophthalmic presentations.

Methods. We created a retrospective multicenter cohort of patients with (1) GCA diagnosed according to the American College of Rheumatology criteria between 1995 and 2015, and (2) stroke occurring at the time of GCA diagnosis or occurring within 4 weeks of starting GCA therapy. The control group consisted of GCA patients without stroke.

Forty patients with GCA-related stroke were compared to 200 control patients (GCA without stroke).

Stroke occurred at GCA the time of diagnosis in 73%, and occurred after diagnosis in 11 patients.

Vertebrobasilar involvement was seen in 73% of patients. Stroke patients were more likely to have ophthalmic ischemic symptoms [63% vs 25% in controls, p < 0.001].

Surprisingly they had lower inflammatory indices, such as C-reactive protein levels (mean 61 mg/l vs 99 mg/l, p = 0.04) and less anemia (59% vs 79%, p = 0.03).

Thus, GCA has an associated increased risk of stroke, especially in those with ophthalmic presentations and the absence of anemia.