Nonarteritic anterior ischemic optic neuropathy (NAION) is a relatively common disorder. The yearly incidence of NAION is 2.3 to 10.2 per 100,000 persons over 50 years of age and 0.5 per 100,000 for all ages.1 Although NAION usually affects patients older than 50 years, 2,3 it may also occasionally occur in younger patients. In a study by Hayreh et al.3 of 406 patients with NAION, the mean age of affected patients was 60 ± 14 years, with a range of 11 to 91 years. Eleven percent of the study patients were younger than 45 years, 49% were between 45 and 64 years, and 40% were 65 years or older. There is no sex predilection.3-5 Caucasians have a smaller cup-to-disc ratio compared to that of African Americans. Most patients affected with NAION are, therefore, Caucasians.6

Ischemic Optic Neuropathies

Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment.

OBJECTIVE Permanent visual impairment has been reported to occur in up to 19% of GCA patients. The aim of this study was to examine whether implementation of a fast-track approach could reduce the rate of permanent visual impairment and inpatient days of care in GCA patients. METHODS A fast-track outpatient GCA clinic (FTC) was implemented in the Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Norway in 2012. The patients included in this study were subsequently recruited between March 2010 and October 2014. Routine clinical and laboratory data and number of inpatient days of care were collected. RESULTS During the observation period, 75 patients were diagnosed with GCA. Among the 75 GCA patients, 32 were evaluated conventionally and 43 in the FTC. In the conventionally approached group, six patients suffered from permanent visual impairment, while in the FTC group only one patient suffered from permanent visual impairment. The relative risk of permanent visual impairment in the GCA patients examined in the FTC was 88% lower compared with the conventionally evaluated group (relative risk 0.12, 95% CI: 0.01, 0.97, P = 0.01). The mean difference in inpatient days of care between patients evaluated conventionally and patients evaluated in the FTC was 3 days (3.6 vs 0.6 days, P < 0.0005). CONCLUSION The implementation of the FTC in GCA care appears to significantly reduce the risk of permanent visual impairment and is more cost effective by reducing the need for inpatient care.

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The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis?

Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis.

Giant cell (temporal) arteritis: an overview and update

Aim —To determine the frequency of skip lesions in an unselected series of temporal artery biopsies and compare the results with other series. Methods —The study was a retrospective review of 102 consecutive temporal artery biopsies taken in a five year period (1992–1997) in one large hospital. Results —35 cases (34.3%) showed evidence of active cranial vasculitis with pathological evidence of inflammation of the intima or media, with or without giant cells. Three of these cases (8.5%) showed apparent skip lesions: normal intima, media, and adventitia in one segment while in other segments there was clear evidence of active vasculitis. Immunocytochemical stains for leucocyte common antigen (LCA) and CD15 were helpful in identifying the absence of intimal or medial inflammatory cell infiltrates within skip lesions. Skip lesions have been described in up to 28.3% of cases in some series, while others have not found evidence of skip lesions or have identified them in a much smaller percentage of cases. Conclusions —In this series skip lesions were relatively rare, accounting for 8.5% of cases of active vasculitis. The degree of inflammation in temporal arteritis is discontinuous. Immunostaining for inflammatory cells, for example LCA and CD15, may be helpful in identifying the presence of an inflammatory cell infiltrate in skip lesion segments of the temporal artery.

https://jcp.bmj.com/content/jclinpath/53/2/137.full.pdf

M J Jeffrey

Papers

The importance of skip lesions in temporal arteritis.