The erythrocyte sedimentation rate is associated with the development of visual complications in biopsy-proven giant cell arteritis

Semin Arthritis Rheum. 2008 Oct;38(2):116-23. doi: 10.1016/j.semarthrit.2007.10.014. Epub 2008 Jan 25.


Objectives: To investigate the potential association between levels of the erythrocyte sedimentation rate (ESR) and specific clinical features of giant cell arteritis (GCA), in particular, visual loss, in a series of consecutive patients diagnosed with GCA at the reference hospital for a well-defined population.

Methods: The case records of all biopsy-proven GCA patients diagnosed at the Department of Medicine of Hospital Xeral-Calde (Lugo, Northwest Spain) between 1981 and 2006 were reviewed. Clinical information and laboratory data including ESR at the time of disease diagnosis were assessed.

Results: Only 10 (3.6%) of the 273 patients had ESR <50 mm/h. Significant differences in the frequency of visual ischemic complications according to different levels of ESR were observed (P = 0.01), mainly due to an increased frequency of visual ischemic events in patients with ESR between 70 and 100/h at the time of disease diagnosis. Twenty-five (21%) of 120 individuals with ESR values ranging between 70 and 100 mm/h experienced permanent visual loss compared with only 10 (7%) of the remaining 153 patients (P = 0.0005; OR: 3.76 [95% CI: 1.73-8.19]). An ESR between 70 and 100 mm/h was the best predictor of visual ischemic complications (OR = 2.29 [95% CI: 1.16-4.55]; P = 0.03) and irreversible visual loss (OR = 3.58 [95% CI: 1.51-8.49]; P = 0.004).

Conclusions: The results from this study show an increased risk of severe ocular complications in biopsy-proven GCA patients presenting with an ESR between 70 and 100 mm/h. Prompt initiation of corticosteroid therapy and close follow-up of these patients is recommended to minimize the risk of irreversible visual loss.

Publication types

  • Comparative Study

MeSH terms

  • Albumins / analysis
  • Alkaline Phosphatase / blood
  • Biopsy, Needle
  • Blindness / etiology*
  • Blood Sedimentation*
  • C-Reactive Protein / analysis
  • Female
  • Giant Cell Arteritis / blood
  • Giant Cell Arteritis / complications*
  • Giant Cell Arteritis / drug therapy
  • Glucocorticoids / therapeutic use
  • Humans
  • Ischemia / etiology*
  • Leukocyte Count
  • Male
  • Platelet Count


  • Albumins
  • Glucocorticoids
  • C-Reactive Protein
  • Alkaline Phosphatase