AB1323 ALL WALES GCA AUDIT 2023-A QUALITY IMPROVEMENT INITIATIVE TO IMPROVE GCA CARE ACROSS WALES
Authors: A. Anjum, A. Negi, G. Huws
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Giant Cell Arteritis (GCA) is the most common primary systemic vasculitis with the highest incidence among persons 70–79 years of age. [1] Because of the significant associated risk of visual loss very early in the disease, timely diagnosis and treatment initiation is crucial. [2] GIRFT (Getting It Right First Time) Programme National Specialty Report 2021 showed that In England, 49% of centres were providing a diagnostic ultrasonography service and 34% of hospitals did not have any formal clinical pathway for assessing GCA. [3] <h3>Objectives:</h3> We decided to audit our GCA services across Wales against the BSR (British Society of Rheumatology) 2020 GCA guidelines. <h3>Methods:</h3> We asked the health professionals from each of the Rheumatology departments in Wales to enter data using a questionnaire, a slightly modified version of the BSR GCA audit tool. The data collection period was 16th January to 6th March 2023. Clinicians were asked to enter data for any GCA patients they saw during this period who were diagnosed within the previous 2 years. <h3>Results:</h3> We received data for 61 patients, (50 males and 11 females). The median age was 60. 21 (34.4%) patients were seen by a Rheumatology clinician within 3 days of initial medical contact (Figure 1). 41 (67.2%) patients received high-dose glucocorticoids within 24 hours of first suspicion of GCA and in 8 cases (13.1%) there was a delay of more than 48 hours. The vast majority of patients had FBC, CRP, ESR or plasma viscosity checked within the first 24 hours of initiation of glucocorticoids. Only 9 (14.7%) patients had Temporal/axillary artery ultrasound performed within one week. It was not available for most cases 45 (73.8%). Temporal artery biopsy was performed in 5 cases, and it was not available for most cases 44 (72.1%). 3T MRI of cranial arteries was performed within 5 days for one patient. PET-CT was not requested for any of these patients, but it was available in 55.7%of cases. Among 26 patients with visual symptoms, 18 had urgent ophthalmology review and Anterior Arterial Ischemic Optic Neuropathy was the most common diagnosis (Figure 2). There was evidence of the documentation of blood pressure in 33 and HbA1c or random blood sugar in 30 cases. 44 (72.1%) patients had appropriate bone protection advised. There was evidence of the provision of written information about this disease to 37 (60.6%) patients. 43 (71.6%) patients were educated about the symptoms of GCA relapse and what to do in that situation. <h3>Conclusion:</h3> Only one-third of patients were assessed within 3 days in the Rheumatology department from the first medical contact. Moreover, in about a quarter of cases, there was a delay of more than 28 days. Most patients had appropriate initial laboratory investigation performed. However, only 9 (14.7%) had temporal/axillary artery ultrasound and only 5 (8.2%) had temporal artery biopsy performed within the recommended time frame. As a result of these findings, we are developing an All-Wales GCA Referral and Diagnosis pathway which will help to streamline timely referral and diagnosis of GCA. <h3>REFERENCES:</h3> [1] Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001. Ann Rheum Dis. 2006 Aug;65(8):1093-8. DOI: 10.1136/ard.2005.046912. Epub 2006 Jan 13. PMID: 16414971; PMCID: PMC1798240. [2] Aiello PD, Trautmann JC, McPhee TJ, Kunselman AR, Hunder GG. Visual prognosis in giant cell arteritis. Ophthalmology. 1993 Apr;100(4):550-5. DOI: 10.1016/s0161-6420(93)31608-8. PMID: 8479714. [3] Kay L, Lanyon P, MacGregor A. GIRFT programme national specialty report for rheumatology. GIRFT, 2021. Available from [www.gettingitrightfirsttime.co.uk/girft-reports/](http://www.gettingitrightfirsttime.co.uk/girft-reports/) [Accessed 10/03/2023]. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>