Specialist nurse training in ultrasonography for the diagnosis of giant cell arteritis.

Abstract

Dear Editor, Ultrasonography is a diagnostic modality that has been tested to OMERACT standards for the diagnosis of GCA [1]. It is a bedside tool with ubiquitously available technology. It can lead to earlier diagnosis or exclusion of GCA, potentially improving outcomes and minimizing glucocorticoid toxicity. Ultrasonography is more cost effective than temporal artery biopsy (TAB) with fewer resources needed to run the ultrasound service [2]. These attributes led it to be the recommended first line investigation for the diagnosis of GCA [3]. However, it is restricted by the availability of trained sonographers. Our centre has a validated GCA fast track pathway [4]. But, it is reliant on the skills of one expert sonographer (C.B.M.), which is a clinical risk. To mitigate this risk a vasculitis specialist nurse (G.D.) has been trained in ultrasonography for the diagnosis of GCA. There is a precedent for a nurse-led temporal artery biopsy service [5]. Temporal arterial biopsy has many limitations including the sampling of a single artery. Ultrasonography has the benefit of examining arteries more extensively, looking for cranial and extra-cranial involvement as recommended by the British Society for Rheumatology [6].