Background Temporal arteritis (TA) is the commonest vasculitis characterised by inflammation of large and medium vessels. It predominantly affects the cranial arteries arising from the aortic arch and requires early recognition and treatment to ensure the avoidance of ischaemic neuro-ophthalmic complications.
Objectives 100% compliance with the British Society of Rheumatology guidelines for TA: Ø Diagnosis criteria Ø Urgent referral for specialist evaluation Ø Inflammatory markers checked before steroid started Ø Temporal artery biopsy (TAB) advised for all the patients with a suspicion of TA Ø Analyse the correlation between inflammatory markers and TAB results Ø and the complex management of this patients.
Methods Retrospective analysis of electronic records of patients that were discharged from acute services with a diagnosis of TA from Brighton and Sussex University Hospital between 1st August 2012 and 31st July 2015.
Patients' blood and TAB results were checked. Specialist letters (Rheumatology, Ophthalmology, Care of the Elderly, TAB clinic) were reviewed electronically. We analized the discharge medication and the advice following specialist review and investigations performed.
Results There were a total of 39 patients with a proposed diagnosis of TA 37 of which had data available for analysis. The average age was 77, 74% were female. Two patients (5%) were referred by the GP for TAB. One of them (50%) had a positive TAB but was not referred for a rheumatology review. Only 62% had TAB from which 46% were positive. 91% of positive biopsies had an ESR>50 and 100% had a CRP>5. All the patients seen in hospital were immediately started on steroids. Only 79% were on Calcium and Vitamin D3, 67% were on Bisphosphonates, 27% were on Antiplatelet treatment and 74% were on a proton pump inhibitor (PPI). 54% of the patients were seen by a Rheumatologist with the diagnosis being confirmed in 86%, even though 44.5% did not have a TAB and 11% had a negative result. One third of the patients had no evidence of secondary care follow up, 13% were seen by Ophthalmology and 2.5% by Elderly Care. From the 46% not seen by a Rheumatologist 11% had a positive TAB and 33% did not undergo TAB. From 8 patients seen by Ophthalmogist 37% were referred for a rheumatology review and only 50% of those with a positive biopsy.
Conclusions In order to achieve 100% standards as set by BSR guidelines based on ACR criteria we need to reinforce GP's to directly refer to Rheumatologist. We recommend that all those patients seen by the medics in hospitals should be referred for Rheumatology review directly as well as those patients seen by an ophthalmologist. Rheumatology review should focus more on the supportive medical management to ensure the BSR guidelines are appropriately implemented. We have proposed a pathway for the investigation, management and specialist review for those patients suspected of Giant Cell Arteritis that will be attached to the discharge letter from the hospital and from the TAB clinics.
The NICE and British Society of Rheumatology guidelines.
Disclosure of Interest None declared