339. coventry Fast-Track Giant Cell Arteritis Pathway With Walk-in Ultrasound: 3 Year Data

Dubey, Shirish; Tiivas, Carl; George, Matthew; Mehta, Purnima

doi:10.1093/rheumatology/kex062.341

Cited by 2 publications

(9 citation statements)

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“…In agreement with the clinical results of other fast-track approaches [22][23][24], the main advantages of the UCLH FTP in GCA are:…”

Section: Discussionsupporting

confidence: 80%

“…In agreement with the clinical results of other fast-track approaches [22–24], the main advantages of the UCLH FTP in GCA are: It offers patients the same day clinical (Rheumatology, and where indicated, Ophthalmology assessment), TAUS assessment in all patients within 24–36 h of presentation, and 18 F-FDG PET-CT assessment within 24–72 h of presentation in case of equivocal findings and as problem-solver; It removes the need for GPs to routinely initiate steroids before specialist assessment, thus avoiding steroid exposure for a large majority of patients who do not have GCA with subsequent reduction in cost and wasted drugs; The combination of TAUS and 18 F-FDG PET-CT allows for high diagnostic accuracy without the need for invasive biopsy; 18 F-FDG PET-CT is able to depict systemic vascular involvement in GCA where dedicated diagnostic TAB and TAUS on temporal arteries is negative or inconclusive for vasculitis. …”

Section: Discussionmentioning

confidence: 57%

“…These increased the confidence in our FTP in detecting GCA. As already demonstrated in the literature, an early diagnosis of GCA and prompt initiation of treatment are essential in preventing visual loss or other complications in GCA patients [22–24].…”

Section: Discussionmentioning

confidence: 99%

“…Its core principles remain similar to that outlined by the first structured GCA services in the UK [22][23][24]:…”

Section: The Goal Of the University College London Hospital Fast-trac...mentioning

confidence: 92%

“…Its core principles remain similar to that outlined by the first structured GCA services in the UK [22–24]: To prevent avoidable GCA-related vision loss and other acute vascular complications by assessing and treating affected patients promptly; To avoid unnecessarily exposing unaffected patients to steroids; To minimize diagnostic delays and anxiety for patients. …”

Section: The Goal Of the University College London Hospital Fast-trac...mentioning

confidence: 99%

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Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging

Ludwig

Vöö²,

Morris

2023

Nuclear Medicine Communications

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Giant cell arteritis (GCA) is a medical emergency, which can lead to irreversible blindness and other ischaemic vascular events if left untreated. Prompt access to specialist assessment, diagnostics in the form of a fasttrack pathway (FTP) and access to appropriate treatment are key factors in preventing morbidity associated with this disease. Recent developments in vascular imaging prompted review of our management of GCA patients. Here, we present the newly implemented FTP in GCA at the University College London Hospital, with added vascular imaging in the form of temporal artery ultrasound (TAUS) and [18F]-fluorodeoxyglucose PETcomputed tomography ( 18 F-FDG PET-CT) with temporal artery biopsy. The initial pilot data on the FTP showed a significant negative predictive value of the combined TAUS and 18 F-FDG PET-CT, and the vast majority of cases positive on imaging were confirmed by biopsy. Through the new FTP in GCA, the diagnosis was completed within 48-72 h, compared with the conventional pathway time of up to 2-3 weeks awaiting biopsy results. Prompt and accurate diagnosis of GCA enables commencement of corticosteroid (prednisolone) treatment in the appropriate patient population while avoiding unnecessary steroid exposure and toxicity in GCA-negative patients. Nucl Med Commun

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“…In agreement with the clinical results of other fast-track approaches [22][23][24], the main advantages of the UCLH FTP in GCA are:…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

“…Its core principles remain similar to that outlined by the first structured GCA services in the UK [22][23][24]:…”

Section: The Goal Of the University College London Hospital Fast-trac...mentioning

confidence: 92%

Section: The Goal Of the University College London Hospital Fast-trac...mentioning

confidence: 99%

See 3 more Smart Citations

Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging

Ludwig

Vöö²,

Morris

2023

Nuclear Medicine Communications

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Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

Hassan¹,

Qadir²,

Dubey³

et al. 2020

NNB

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Background: Giant cell arteritis (GCA) is the most common type of systemic vasculitis affecting the elderly. Ophthalmic presentations of GCA in particular can be difficult to identify prior to permanent visual loss occurring. Methods: Here, we present 3 challenging cases as a retrospective series to highlight the variable presentations of GCA with ophthalmic involvement, but GCA was not suspected due to atypical presentation. Results: Unfortunately, all 3 cases went on to develop visual loss in the affected eye due to a delay in diagnosis or treatment. The authors wish to highlight the challenges posed to the referring clinicians, when patients had systemic/ocular co-morbidities, which delayed the suspicion of GCA Conclusion with a Practical Point: Our cases highlight the variable presentations of this condition as well as the devastating ophthalmic implications that GCA can have. A high index of suspicion must be maintained; particularly in elderly patients with atypical presentations.

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339. coventry Fast-Track Giant Cell Arteritis Pathway With Walk-in Ultrasound: 3 Year Data

Cited by 2 publications

References 0 publications

Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging

Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging

Challenges in the Diagnosis of Giant Cell Arteritis Before Visual Loss

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