Background GCA is the most common primary systemic vasculitis associated with siginificant morbidity. Guidance on management have been issued by the British Society for Rheumatology (BSR) and European League Against Rheumatism (EULAR).
Objectives We as a rheumatology department wished to identify if our current practice in diagnosing and managing GCA was adequate. A retrospective study looking at rheumatology patients with GCA who had temporal artery biopsy (TAB) between November 2006-November 2010 was performed. BSR and EULAR recommendations were used as standards
Methods 131 patients across all specialties had TAB for GCA. We analysed only patients who were seen and managed exclusively within the rheumatology department.
Results 46 rheumatology patients (31 females, 15 males) with a diagnosis of GCA had TAB. Mean age at diagnosis was 68 years. Mean time between commencement of symptoms and TAB performed was 62.26 days, between commencement of steroids and TAB performed was 28.88 days; and between first Rheumatology appointment and TAB performed was 17.88 days. 9 and 13 patients were not started on bisphophonates and gastroprotection respectively when steroids were commenced. 33 patients were not started on aspirin when diagnosed. 44 patients received adequate steroid dose tapering advice but did not receive a leaflet on temporal arteritis and steroid therapy, and a steroid card on commencement of steroid therapy.
Conclusions Key areas for improvement include earlier recognition of symptoms by patients and primary care, shorter duration between commencement of steroids and TAB being performed, improvement in time between first rheumatology appointment to TAB; and increased use of aspirin, bisphosphonates and gastroprotection.
Dasgupta B et al. BSR and BHPR Guidelines for the management of giant cell arteritis. Rheumatology 2010;49(8):1594-1597.
Mukhtyar C et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009;68:318-323.
Disclosure of Interest None Declared