Diagnostic delay in patients with giant cell arteritis: results of a fast-track clinic

Abstract

Giant cell arteritis (GCA) can lead to severe complications if left untreated. The aim of this study was to describe time from onset of symptoms to diagnosis and treatment in GCA suspected patients in a fast-track clinic (FTC), and secondarily to assess the influence of GCA symptoms on this time. A retrospective cohort consisting of suspected GCA patients who visited the FTC between January 2017 and October 2019 was used. Time between symptom onset, first general practitioner visit, FTC referral, first FTC visit, and treatment initiation was analysed. Furthermore, this was stratified for subtypes of GCA and GCA symptoms. Of 205 patients referred with suspected GCA, 61 patients received a final diagnosis of GCA (GCA+) and 144 patients had no GCA (GCA−). Median time after onset of symptoms to first FTC visit was 31.0 days (IQR 13.0–108.8) in all referred patients. Time between onset of symptoms and first GP visit was 10.5 (4.0–36.3) days, and time between first GP visit and FTC referral was 10.0 (1.0–47.5) days. Patients were generally seen at the FTC within 1 day after referral. For patients with isolated cranial GCA (n = 41), median delay from onset of symptoms to treatment initiation was 21.0 days (11.0–73.5), while this was 57.0 days (33.0–105.0) in patients with extracranial large-vessel involvement (n = 20) (p = 0.02). Our results indicate considerable delay between symptom onset and FTC referral in patients suspected of GCA. Suspected patients were examined and GCA+ patients were treated instantly after referral.Key Points• GCA can cause severe complications with delayed treatment, but non-specific symptoms make diagnosis challenging.• Diagnostic delay still occurs despite introducing a successful fast-track clinic resulting from delay between start of symptoms and FTC referral.• Patients who presented with constitutional symptoms had longer delay than patients who presented with isolated cranial symptoms.