Experiencing visual symptoms is not associated with diagnostic delay in patients with giant cell arteritis (GCA), according to research results published in Rheumatology International.
Researchers conducted a study of patients with prevalent GCA to compare general and GCA-specific characteristics of visual symptoms and to examine the association between visual symptoms and diagnostic delay.
For the collection of cross-sectional data, adult patients (aged ≥50 years) with GCA from across the United Kingdom had to complete a questionnaire; recruitment occurred between January 2015 and September 2016.
Researchers mailed questionnaires to 534 patients with GCA; 318 patients (mean age, 73.7±8.2 years; 69.8% women) from 130 general practices responded (adjusted response rate, 59.6%). A total of 28.3% (n=90) of patients reported a current visual symptom; 55% of these were new cases of patients who reported visual symptoms developing after GCA diagnosis.
No significant differences in demographic factors were noted among the groups with and without current visual symptoms. Anxiety (P= .23) was the most frequent self-reported comorbidity in patients with visual symptoms. Compared with patients with visual symptoms, those without visual symptoms had better mean Short Form Health Survey (SF)-12 Physical Composite and Mental Health Composite scores.
The 3 most common symptoms reported by patients before GCA diagnosis were headache, tiredness or fatigue, and temporary vision problems, occurring in 82.2%, 63.3%, and 52.2%, respectively. Patients with GCA without vision symptoms were most likely to experience headache, scalp tenderness, and tiredness or fatigue (87.3%, 59.7%, and 57.8%).
Among all patient responders, median length of consultation delay was 14 days (interquartile range [IQR], 7-42 days), with a 14-day diagnostic delay (IQR, 4-35 days) and a total delay of 35 days (IQR, 18-91 days). Using linear regression analysis with bootstrapping, adjusted for age, sex, and deprivation, researchers found no significant difference between the number of days of consultation, diagnostic, or total delays between patients with GCA with or without current visual symptoms.
Limitations of this work included the cross-sectional, self-reported nature of the study, which may have introduced selection and recall biases. Investigators were also limited by the inability to determine whether a subset of patients with poorer vision may not have been able to respond to the mailed survey.
“Visual symptoms remain a serious and common problem among patients with GCA,” the researchers concluded. “Though both patient and healthcare-related delay persists, this appears to be less than previously reported and visual symptoms may not be related to the extent of the delay experienced.”
Chean CS, Prior JA, Helliwell T, et al. Characteristics of patients with giant cell arteritis who experience visual symptoms. Rheumatol Int. 2019;39(10):1789-1796.