Delays in recognition and management of giant cell arteritis: results from a retrospective audit

Prompt institution of corticosteroids (CS) can prevent devastating neuro-ophthalmic complications (NOC) in patients with giant cell arteritis (GCA). Guidelines on managing GCA place emphasis on early recognition of symptoms and prompt treatment of the disease where there is a high index of clinical suspicion. The aims of this study are to review the clinical findings in patients with GCA, evaluate the baseline practice in diagnosis and treatment and to identify delays in treating patients with NOC. The study utilised retrospective case notes review of patients diagnosed with GCA between 2003 and 2008. Sixty-five patients were identified (47 females, 18 males, mean age, 75 years). A significant minority presented with constitutional, polymyalgic and ischaemic symptoms. Mean time from symptom onset to diagnosis of GCA was 35 days. CS were not delayed in those diagnosed with GCA. Recognition of ischaemic symptoms was slow. Visual loss at presentation occurred in 16 patients (24.6%). Ten patients (15.4%) presented with NOC in the absence of headache, seven (70%) of whom developed permanent visual impairment. Five (7.7%) patients had cerebrovascular complications. There are major delays in the recognition and treatment of GCA. There is a high incidence of irreversible ischaemic complications which may partly result from diagnostic and treatment delay.