The characteristics of giant cell arteritis patients that went blind in spite of treatment: case based narrative literature review.

Giant cell arteritis (GCA) is a medium and large vessel vasculitis. Vision loss is considered the most serious complications traditionally attributed to untreated disease. Urgent corticosteroids (CS) therapy is the standard of care and is considered adequate to prevent blindness. However, in some rare cases blindness may occur despite implementation of the appropriate treatment. We aimed to find patients who went blind despite high dose CS therapy and identify unique features of them together with conducting narrative review of previous case reports to characterize this group in search of common potential risk factors. Cases of blindness prior to treatment induction were not analyzed here. We identified 2 patients in our records who went blind despite high dose CS therapy. We found some repeated common features in patients that went blind in spite of treatment: advanced age, preexisting pronounced arteriosclerosis, thrombocytosis, contraindication to full dose CS therapy resulting in lower doses of CS within the recommended ranges. Defining the subgroup of GCA patients that went blind in spite of proper CS treatment requires further attention as they might potentially benefit from more aggressive therapy (e.g. early introduction of disease-modifying antirheumatic drugs).