E042 The Newcastle Giant Cell Arteritis (GCA) Fast Track Clinic: a clinical service evaluation

Abstract

Abstract Background/Aims Patients with suspected new-onset giant cell arteritis (GCA) require urgent specialist assessment to establish a diagnosis. Early review reduces unnecessary treatment with high dose glucocorticoids in those without GCA and enhances sensitivity of temporal artery ultrasound. Ensuring patients are rapidly triaged and diagnosed poses a logistical challenge for rheumatology departments working alongside colleagues in both primary care and ophthalmology. To address this, we established a rheumatology-led Newcastle Hospital GCA fast track clinic, a service led by four consultant rheumatologists who perform clinical assessments and temporal artery ultrasound scans. Methods Data were collected prospectively from 2017. We performed a clinical service evaluation based on a retrospective review of clinical records of patients assessed in this service between 2017 to 2020. Results A total of 626 consecutive patients were assessed, with 145 (23%) diagnosed with GCA over the four-year period. Average age was 72 (range 41-96 years) and 452 (72%) were female. The cardinal symptoms of headache, jaw claudication and visual disturbance were present in 518, 103 and 283 patients respectively. The majority of referrals came from ophthalmology (42%) and primary care (34%). 614 patients had an ultrasound scan performed, returning a positive result in 121 (19.7%), negative in 415 (67.6%) and inconclusive in 78 (12.7%). A biopsy was requested for 147 patients over the four-year period; 33 were positive, 95 negative and six were inconclusive. Within this cohort, 47 patients had a biopsy performed despite a negative ultrasound scan, of which five were found to be positive for GCA. Conclusion Our data illustrate the key clinical, imaging and histological findings within one of the largest inception cohorts of GCA in the UK and demonstrate the feasibility of a one-stop rapid access clinical service for patient benefit. Disclosure C.M. Lin: None. J. Berry: None. B. Thompson: None. J. Heaney: None. K. Houghton: None. K. Baker: None. G. Reynolds: None. A. Lorenzi: None.