AB0708 The use of temporal artery biopsies (TAB) in diagnosis and management of patients with giant cell arteritis (GCA)- a re-audit in rheumatology in the belfast health and social care trust (BHSCT). (12th June 2018)

• Record Type: Journal Article
• Authors: Laverty, U.A.; Banks, E.; McHenry, M.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1494
• Page End: 1494
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.7339
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Patients should meet at least 3/5 American College of Rheumatology (ACR) criteria for a diagnosis of GCA. British Society of Rheumatology (BSR) guidelines on the management of GCA from 2010 emphasise the importance of early referral for specialist management. TAB should be considered depending on local experience and availability of other imaging modalities. Biopsy should be at least 10 mm in length and ideally done within 14 days of presentation. TABs performed in BHSCT over a three-year period were audited in 2014. Objectives: We re-audited the Rheumatology TAB referrals in the BHSCT from August 2016 to August 2017 to assess how biopsies influenced the management of patients with GCA in comparison to the previous audit. Methods: Histopathology based LabCentre search detected 36 TABs within the given period. A retrospective audit was carried out with the use of Electronic Care Record and 16 of these patients were Rheumatology based TAB referrals. A proforma was used to aid data collection. Results: Female:Male ratio was 2.2:1, age range was 61–91 with a mean age of 76. 94% of patients presented with headache. Of those patients referred for biopsy, 100% already fulfilled 2 of ACR criteria, compared with only 80% in previous audit. TAB was positive in 25%. In those with a positive biopsy, 75% had an ESR >50. All patients were on steroid treatment at the time of biopsy. In 42% of patients with a negative biopsy, steroids were rapidly reduced. 100% of patients with a positive biopsy continued on steroids. 68% of biopsies were greater than 10 mm compared with 38% in the previous audit. 68% of patients had a TAB within 14 days of commencing on steroids, with 31% having biopsy within 7 days of commencing steroids. 63% of patients developed steroid related complications. In 56% of patients the biopsy result changed patient management. Conclusions: The percentage of appropriate referrals for biopsy (based on the ACR criteria) has improved compared with the previous audit. The length of biopsy improved. 32% of patients were waiting longer than 2 weeks for biopsy but some of these patients presented late to the rheumatology team. Biopsy results changed management in 56% of patients. Areas for consideration include improvement in time to biopsy and biopsy length. Reference: [1] BSR and BHPR guidelines for management of giant cell arteritis. Bhaskar Dasgupta, et al. Rheumatology, Volume 49, Issue 8, 1 August 2010, Pages 1594–1597. Published: 05 April 2010 Disclosure of Interest: None declared