GCA - risks and protections

Q: Q: Fever and elevations of the acute phase reactants are indicators for higher risk of vision loss in Giant Cell Arteritis (GCA)?

A) True

B) False

Answer: B

In paradox to expectations that high inflammatory status as fever, elevations of the acute phase reactants such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin (IL) 6, as well as anemia will increase the risk of vision loss in GCA - they are found to be protective. This is due to two reasons. IL-6 has angiogenic properties and counteracts arteritis-induced ischemia. Second, severe inflammatory responses lead patients to seek medical care early in the process.

#rheumatology

References:

1. González-Gay MA, García-Porrúa C, Llorca J, et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine (Baltimore) 2000; 79:283.

2. 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; 43:1393.

3. Cid MC, Font C, Oristrell J, et al. Association between strong inflammatory response and low risk of developing visual loss and other cranial ischemic complications in giant cell (temporal) arteritis. Arthritis Rheum 1998; 41:26.

4. Nesher G, Nesher R, Mates M, et al. Giant cell arteritis: intensity of the initial systemic inflammatory response and the course of the disease. Clin Exp Rheumatol 2008; 26:S30.