Background Giant Cell Arteritis (GCA) is the commonest large vessel vasculitis yet a full time UK general practitioner (GP) can expect to see just 1 case every 1-2 years [Barraclough]. GCA may be difficult to identify, particularly in atypical cases. For example headache has been shown to be absent in just under a quarter of GCA patients which may falsely reassure clinicians resulting in delayed diagnosis and potential visual loss [Ezeonyeji].
Objectives The aim of this study was to investigate how GPs identify GCA.
Methods A postal questionnaire survey of 5000 randomly selected UK general practitioners was undertaken. Questions included experience of managing patients with GCA, presenting symptoms used to identify GCA and the referral pathways used.
Results 1249 questionnaires were returned. The mean age of responder was 43 years and they had been qualified as a GP for a mean of 14 years (SD 9.03). Respondents were more likely to be from larger practices. 879 responders (70.4%) indicated that they had diagnosed and managed a patient with GCA. Figure 1 illustrates the combinations of the main symptoms that GPs use to identify GCA with headache being the predominant feature (n=1071 (86%)). Other commonly reported features were visual disturbances (n=671 (53.9%)), jaw symptoms (n=420 (33.7%)) and temporal artery/scalp tenderness (n=468 (37.6%)). 21.86% (n=273) indicated that they only use headache as a symptom for identifying GCA.
Conclusions General practitioners in the UK rely overly on headache when diagnosing GCA. Educating clinicians about other presenting symptoms and atypical presentations is essential to optimise diagnosis and reduce the potential for visual loss for this patient group and to reduce potentially serious long term complications.
Barraclough K et al. Br J Gen Pract. 2012 Jun;62(599):329-3
Ezeonyeji A et al. Clin Rheumatol. 2011;30(2):259-262
Acknowledgements Administration and support staff at Keele University Department of Primary Care and Health Sciences.
IT Staff Zoe Mason and Ashley Ford.
Disclosure of Interest None declared