Neuro-ophthalmic challenges and multi-morbidity in vasculitis among the older adults

ABSTRACT

Introduction

Vasculitides are a heterogeneous group of disorders producing inflammation of blood vessels (e.g. arteries or veins). All major vasculitides potentially have ophthalmological symptoms and signs including visual loss. Co-morbidity, multimorbidity, polypharmacy, and geriatric syndromes all play important roles in patient outcomes for these rheumatic conditions in the elderly. This monograph reviews the NCBI PubMed database (Feb 2023) literature on the neuro-ophthalmic and geriatric considerations in vasculitis.

Areas covered

Cogan Syndrome, Granulomatosis with Polyangiitis, Giant Cell Arteritis, Polyarteritis Nodosa, Takayasu Arteritis, Vasculitis epidemiology, and neuro-ophthalmological symptoms.

Expert opinion

Geriatric patient care for vasculitis with neuro-ophthalmological manifestations can be complicated by the interplay of multiple co-morbidities, polypharmacy, and specific geriatric syndromes. The valuation and treatment of vasculitis and the complications associated with the disease can negatively impact patient care. Advances in noninvasive imaging and updates in diagnostic criteria have enabled increased identification of patients at earlier stages with less severe disease burden. Novel therapeutic agents can be glucocorticoid sparing and might reduce the adverse effects of chronic steroid use. Holistic care models like the 5 M geriatric care model (mind, mobility, medications, multicomplexity, and matters most) allow patients’ needs to be in the forefront with biopsychosocial aspects of a patient being addressed.

KEYWORDS:

• Giant cell arteritis
• geriatric care
• multi-morbidity
• neuro-ophthalmological manifestations
• Takayasu arteritis
• vasculitis treatment

Article highlights

• Primary systemic vasculitides may have different incidence and prevalence in older adults. Giant cell arteritis (GCA) is the most common large vessel vasculitis in the geriatric population but other vasculitic disorders may also occur in older patients.

• Systemic vasculitis can have important neuro-ophthalmological manifestations in older adults which can include stroke and blindness, leading to further deterioration in patient care.

• The classification criteria and epidemiology are crucial factors in the evaluation and management of common vasculitis affecting older adults.

• The most commonly used treatments for vasculitis (including glucocorticoids and other immunosuppressive agents) have significant side effects in older patients. Distinguishing activity of disease from treatment related side effects in geriatric populations requires a multidisciplinary, integrated, and coordinated approach.

• Comprehensive geriatric assessment models like the 5 M model of geriatric care (mind, mobility, medications, multicomplexity, and matters most) consider the complexity of geriatric patient management and may be useful for these older patients to avoid co-morbidities and iatrogenic complications of treatment.

Declaration of interests

A Lee is a consultant for the National Football League, NASA, Horizon, Astra/Zeneca, Bristol Myers Squibb, Stoke. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

A Lee – conception, draft review, and editing; C Keshvani- first draft manuscript; C Keshvani, N Laylani, P Davila-Siliezar, J Kopel – draft review and editing.

Additional information

Funding

This paper was not funded.