P013 Diagnosis and Management of Giant Cell Arteritis Patients in Cardiff and Vale University Health Board (January 2017-February 2020)

Abstract

Abstract Background/Aims Giant cell arteritis (GCA) is a medical emergency presenting with a new-onset headache. Delay in treatment can cause permanent vision loss and other complications. It responds quickly to oral and parenteral steroids. Temporal artery biopsy (TAB) is the gold standard. However, it is not easily available in a timely manner and can produce normal results due to skip lesions and if done after starting steroids. In contrast, ultrasound (USS) is a useful non-invasive alternative. The aims of this audit were to study our current practice against the NICE guidelines/BSR pathway on GCA management, to evaluate the impact of USS on diagnosis and management of GCA and the use of tocilizumab and steroid-sparing synthetic DMARDs. Methods This is a retrospective, audit study on patients with a new diagnosis of suspected GCA referred to the Cardiff and Vale Health Board from January 2017 to February 2020. 105 patients who had a USS doppler test were identified, 51 were excluded due to various reasons, ultimately data on 54 patients were analysed. Results 50 patients (93%) were >50 years old; female: male was 4:1.5. 44 (81%) were primary care referrals. 50 (93%) were seen by a rheumatologist within 48 hours. 11 had visual symptoms, all had an ophthalmology review, two had ischemic changes suggestive of GCA. Pre-USS, 21/54 (39%) were classed as likely GCA. Post-USS, 19/54 (35%) were confirmed GCA, two were refuted. Only 3/54 showed signs of GCA on USS (sensitivity: 15.79%). TAB was done in five patients (sensitivity: 20%), 1/5 showed GCA, all had negative USS. The low sensitivity of USS and TAB is likely to be due to steroid exposure, as all patients were on steroids at time of USS and three had the biopsy 2 weeks post-steroid use. 19 patients continued on steroids for GCA. At 12 months follow-up, 2/19 had discontinued steroids, only 4/17 were on prednisolone >10mg. None of the patients in our cohort required tocilizumab or other steroid-sparing agents. Conclusion Temporal artery USS is useful in aiding the GCA diagnosis and reduces the need for TAB, especially in patients with low clinical probability of GCA. Clinical assessment, USS and ophthalmology review together can avoid unnecessary exposure to long-term steroids. It is reassuring that the majority of patients with a low GCA probability had a normal USS. This helped in avoiding steroid use and/or to stop steroids quickly in those who had already started steroids. A local pathway for management of patients referred as suspected GCA is being established in the department. Teaching sessions for non-rheumatologists involving BSR Guidelines on GCA might help reduce unnecessary referrals and improve standard of care. We aim to study the reasons for the low utilisation of tocilizumab and other steroid-sparing agents. Disclosure J. Yau: None. M. Saleh: None. A. Negi: None.