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E. Heron, I. Rossignol, R. Kassaei, M. Beaudrimont, S. Feldman–Billard; The screening for giant cell arteritis in patients with acute anterior ischemic optic neuropathy. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1596.
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Purpose: Acute anterior ischemic optic neuropathy (AAION) is the main ocular complication of giant cell arteritis (GCA). Systemic symptoms and signs of GCA may be lacking in patients with ocular manifestations of the disease, while the erythrocyte sedimentation rate (ESR) may be normal, and the sensitivity of the C–reactive protein (CRP) in such cases is not well established. We evaluated the interest of a systematic temporal artery biopsy to screen for GCA in patients with AAION. Methods: Since february 2001, all patients aged over 50 hospitalized in our Eye Center with AAION were screened for GCA according to a standardized procedure. The ESR and CRP level were measured on an emergency basis, before corticosteroid therapy. All patients were examined by an internist and responded to a standardized questionnaire, to record any systemic sign or symptom suggestive of GCA. Then, a temporal artery biospy was systematically done. The upper normal ESR value was estimated in reference to a well established formula, i.e. age (yrs) / 2 in men, and (age + 10) / 2 in women. The upper normal CRP value in our laboratory is 10 mg/l: results are given as "< 10 mg/l" or with the exact value when 10 mg/dl or more. All biopsies were reviewed by a trained anatomopathologist and the diagnosis of GCA was kept only for patients with typical histological findings. Results: Between february 2001 and january 2003, 96 consecutive patients with AAION, 59% men, aged 53 to 98 years (median, 71 yrs) were screened according to the planed procedure. A histologically proven diagnosis of GCA was made in 20 patients (sex ratio, 1) aged 61 to 98 years (median, 81yrs). Of them, 5 (25%) had occult temporal arteritis (no suggestive sign or symptom), 7 (35%) had a normal ESR (4 to 42 mm at first hour), and 4 patients (20%) had normal CRP values. ESR and CRP values of the 20 GCA patients were regularly distributed from 4 to 85 mm at first hour and "< 10" to 160 mg/l respectively, with no cut off value for any of these two markers of inflammation. Two of the 20 GCA patients (10%) had neither clinical nor biological marker suggestive of the disease. Conclusions: AAION can be the presenting manifestation of giant cell arteritis, without other clinical and/or biological abnormality suggestive of the disease in about 20% of patients. A temporal artery biopsy should systematically be performed in patients with AAION, at least over 60 years of age, to screen for giant cell arteritis.
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