306. How Do General Practitioners Manage Suspected Giant Cell Arteritis

Helliwell, Toby; Muller, Sara; Hider, Samantha L.; Richardson, Jane; Mallen, Christian

Abstract

Background: Background: GCA is the commonest large vessel vasculitis yet a full time UK general practitioner (GP) can expect to see just one case, at most every 1–2 years. Untreated GCA can lead to permanent visual loss, thus it is essential GPs recognize and instigate appropriate management at an early stage, including urgent referral for specialist review and diagnostic confirmation. Our objective was to investigate the management of GCA in UK General Practice and to identify barriers to effective treatment.

Methods: A postal questionnaire survey of 5000 randomly selected UK GPs. Questions included experience of diagnosing and managing patients with GCA. Simple descriptive statistics were used for the closed response data and thematic analysis was used for open ended questions.

Results: 1249 (25.14%) questionnaires were returned. The mean age of responders was 43 years and they had been qualified as a GP for a mean of 14 years (S.D. 9.03). 879 responders (70.4%) indicated that they had managed a patient with GCA. In line with UK guidance, 983 (78.7%) of responders reported that they initiated treatment with between 40 and 60 mg of prednisolone. 244 (20%) responders would refer patients immediately to hospital without doing any investigations whereas 201 (16.5%) would only refer if initial investigations were abnormal. Less than half of GPs would initiate glucocorticoid treatment prior to referral. There were marked reported differences in referral pathways with 38.3% (n = 478) referring to rheumatology, 29.3% (366) to ophthalmology and 11.5% (n = 144) referring to general medicine. Speciality referral was dependent on clinical presentation. Older patients were often referred to elderly care services while patients with visual symptoms were referred to ophthalmology (if available) or acute services such as accident emergency or acute medicine. Thematic analysis of free text comments highlighted the frustration and difficulties GP have with accessing specialist care with some responders having to arrange temporal artery biopsy prior to specialist review. GPs were also concerned about a lack of fast track pathways to support this patient group.

Conclusion: There are marked differences in the treatment and assessment of patients with GCA in the UK, with conflicting referral pathways and difficulties in accessing appropriate services. While the majority of GPs responding to this survey use appropriate doses of glucocorticoids, many would not initiate early treatment, contrary to current guidance. The development of a national standard for fast tracking suspected GCA patients to relevant expertise and further clinical education of GPs would be beneficial to improve care and outcomes for patients with GCA.

Citation

Helliwell, T., Muller, S., Hider, S. L., Richardson, J., & Mallen, C. (2015). 306. How Do General Practitioners Manage Suspected Giant Cell Arteritis. Rheumatology, 54(S1), https://doi.org/10.1093/rheumatology/kev090.071

• Journal Article Type: Article
• Online Publication Date: Apr 20, 2015
• Publication Date: 2015-04
• Deposit Date: Oct 13, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 54
• Issue: S1
• DOI: https://doi.org/10.1093/rheumatology/kev090.071