Background Giant cell arteritis (GCA) although the commonest large vessel vasculitis, is relatively uncommon in primary care. However, given the potentially serious complications of GCA including visual loss, general practitioners (GPs) need to recognise suspected GCA early and instigate appropriate management. UK BSR guidelines advocate early referral for specialist review and the initiation of treatment with high dose corticosteroids to minimise the likelihood of visual loss 
Objectives The aim of this study was to investigate steroid management and referral patterns for GCA amongst UK GPs.
Methods A postal questionnaire survey of 5000 randomly selected UK GPs was undertaken. Questions included experience of managing patients with GCA, initial steroid doses used and the referral pathways of suspected GCA.
Results 1249 GPs responded (corrected response rate of 25.1%). Responders had a mean age of 44 years (SD 9.2) and had been qualified as a GP for a mean of 14 (SD 9.03) years. Respondents were more likely to be from larger practices. 879 responders (70.4%) indicated that they had diagnosed and managed a patient with GCA. The most common initiating dose of prednisolone was 60mg, although this varied widely (figure 1). Once GPs had suspected the diagnosis, 478 respondents (38.3%) indicated that they refer to rheumatology, 366 (29.3%) would refer to ophthalmology, 144 (11.5%) would refer to general medicine and 35 (2.8%) would refer to accident and emergency. Table 1 illustrates the action taken by respondents when GCA is suspected.
Conclusions These results show that there appears to be wide variation amongst responders in how suspected GCA is managed in general practice. This is likely to be due to variation in the availability of relevant services. However, it may also reflect GPs training and previous experience. Referral pathways that allow urgent specialist review for diagnostic confirmation are essential to avoid the serious complications of GCA, but also inappropriate over treatment of patients who do not have the disorder.
Dasgupta B et al. Rheumatology (Oxford). 2010 Aug;49(8):1594-7.
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
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