Background Giant Cell Arteritis (GCA) is associated with potentially devastating complication e.g. visual loss, scalp necrosis etc. Prompt assessment and initiation of treatment can prevent these potential complications.
Objectives The British Society for Rheumatology (BSR) and Royal College of Physicians (RCP) have produced guidelines in 2010 on the management of GCA. This audit set in Northern Lincolnshire and Goole NHS Foundation Trust aimed to review whether these guidelines were being adhered to.
Methods Patients medical records from 1st September 2010 to 31st august 2014 were audited retrospectively. Any patient with a diagnosis of suspected GCA was eligible to be included. The standards set for the audit were taken from national guidelines implemented by the BSR/BPHR and RCP. Audit committee approval granted. Overall 5 standards were set for the audit questionnaire. These included Presenting features, clinical investigations, referral for TAB, referral for specialist (Rheumatologist or Opthalmologist) opinion, initial and follow up treatment.
Results 24 patient's medical records were included in the audit including 25% male and 75% female with age range 56 years to 83 yrs old and mean age of 70yrs. All patients had _>2 key clinical features documented in the notes. Of these, Headache questioned in 100%, Jaw Claudication questioned in 100%, Visual Symptoms questioned in 83.3%, Limb Claudication and Bruit questioned in 20.8%, Proximal pain and stiffness questioned in 87.5%. All patients had _>2 clinical investigations done at presentation. Of these, ESR checked in 100%, CRP checked in 95.8%, FBC checked in 100%, U&Es checked in 87.5%, LFTs checked in 5%, CXR checked in 37.5%, Urinalyses checked in 62.5%. 75% patients had temporal artery biopsy. Of these 66.7% had a biopsy within the target time of 7 days. Of these TAB was positive in 61%. 79.16% of patients were seen by a specialist within 7 days of referral. 62.5% patients were commenced on the correct dose of steroids (25% prescribed higher than recommended dose and 16.7% prescribed lower than recommended dose of steroids). 91.7% of patients were prescribed a bisphosphonate and calcium/vitamin D supplement. 8.3% patients were prescribed Aspirin.
Conclusions Initial assessment and investigation of patients with suspected GCA was generally well managed, with the relevant clinical features being documented and appropriate investigations being performed. However, TAB and consultation with a specialist consultant should have been within 7 days of the initial presentation. This audit showed that only 75% and 79.16% of patients were managed within the target time for a TAB and specialist input respectively. This was largely due to a delay in the referral system. Aspirin was prescribed in only 8.3% of suspected GCA patients, mainly due to low level of evidence (Level of evidence 3, strength of recommendation C). We recommend a template in a computerized format by referrers and adherence to the guidelines by physicians would greatly improve the managment of GCA patients.
BSR, BHPR and RCP Guidelines for the management of giant cell arteritis. Bhaskar Dasgupta, Frances A. Borg, Nada Hassan, Leslie Alexander, Kevin Barraclough, Brian Bourke, Joan Fulcher, Jane Hollywood, Andrew Hutchings, Pat James, Valerie Kyle, Jennifer Nott, Michael Power and Ash Samanta.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.