AB0603 SCOTLAND’S FIRST FAST TRACK TEMPORAL ARTERY ULTRASOUND REFERRAL PATHWAY FOR SUSPECTED GIANT CELL ARTERITIS

Abstract

Background: Giant cell arteritis (GCA) is associated with loss of vision (LOV). Rapid referral for specialist assessment including temporal artery ultrasound (TAU) reduces the risk of LOV and the need for temporal artery biopsy (TAB). Two Consultant Rheumatologists (JSM & JHG), formally trained in TAU, established Scotland’s First Fast Track Referral Pathway for Suspected GCA using TAU on 21.03.17. A third Consultant (SJH), whose formal Vascular ultrasound training occurred later, joined the Service on 10.04.18. We present here our Outcome data and also our experience of this new Service for NHS Fife, the first of it’s kind in Scotland. Methods: We prospectively recorded data on all referrals to our Fast Track Service for patients with suspected GCA from 21.03.17 onwards. NHS Fife covers a population of 370,000 and constitutes 6.8% of the Scottish Population (5,425,000). Results: Up until 20.11.17 (20 months) we received a total of 142 referrals, representing an average of 7 per month, or around 2 per week. 54 (38%) were deemed to have a very low probability of GCA based on their age, history & CRP and were not seen or scanned. 88 (62%) of referrals underwent Fast Track assessment including TAU (62 F; 26 M); Mean age 71 (range 52-88). Time from referral to assessment was as follows : (25) 28% were seen on the same day; (60) 68% were seen by the next day; (69) 78% were seen within 2 days of referral; (84) 95% were seen within 3 days of referral. 25/88 (28%) patients were diagnosed with GCA. Of these, 14 patients had a positive TAU and did not require TAB. 9 patients had an equivocal or negative TAU and were diagnosed on TAB. Only 1/25 GCA patients experienced LOV (4%). The patient was an 82 year old male diabetic who presented to Ophthalmology with unilateral LOV but no symptoms of GCA and also with a normal CRP (4.1mg/L). However, he had stopped 1mg of prednisolone for PMR 2 weeks prior to developing LOV. TAU was positive, but in view of the atypical nature of his symptoms (“silent GCA”) & normal CRP, he also underwent TAB, which was positive confirming the diagnosis of GCA. I patient had a negative TAU and TAB, but was subsequently diagnosed with LVV on axillary artery US. Conclusion: A previous survey of 20 GCA patients diagnosed in Fife over a 2 year period (Jan 2007 - Jan 2009) recorded a 50% rate of LOV. This was largely attributed to delayed referral. We have now successfully introduced Scotland’s First Fast Track Referral Pathway for Suspected GCA using TAU. This has led to a dramatic reduction in Morbidity in terms of LOV ( Disclosure of interests: None declared