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Published on: February 8, 2019
Challenges of diagnosis and management of giant cell arteritis in general practice: a multimethods study
Toby Helliwell1, Sara Muller1, Samantha L Hider1,2
1Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.
Insights
General practitioners in the UK may miss giant cell arteritis (GCA) by over-relying on headache. Improved fast-track referrals are needed to prevent vision loss from this rare condition.
Area of Science:
- Rheumatology
- General Practice
- Diagnostic Challenges
Background:
- Giant cell arteritis (GCA) is a rare but serious condition where early diagnosis by UK general practitioners (GPs) is crucial to prevent complications like permanent vision loss.
- Little is known about the diagnostic and management approaches and challenges faced by GPs when dealing with suspected GCA.
Purpose of the Study:
- To investigate the current diagnosis and management strategies for suspected GCA within UK general practice.
- To identify challenges faced by GPs in diagnosing and managing GCA.
Main Methods:
- A mixed-methods approach was employed, including a postal survey of 5000 UK GPs and semistructured telephone interviews with 24 GPs.
- Data were collected on diagnostic criteria, management practices, referral pathways, and perceived challenges.
Main Results:
- 70% of surveyed GPs reported diagnosing and managing GCA, but diagnostic reliance on headache was noted (21.9% would exclude GCA if absent).
- Significant regional variations in referral pathways and challenges in accessing specialist care were reported.
- GPs expressed concerns about missing GCA diagnoses and the adverse effects of long-term glucocorticoid treatment.
Conclusions:
- UK GPs may over-rely on headache for GCA diagnosis, leading to potential delays.
- Conflicting referral pathways and difficulties accessing specialist services highlight the need for standardized care.
- A national fast-track referral pathway for suspected GCA is recommended to improve patient outcomes.
Background:
In the UK, general practitioners (GPs) are usually the first medical contact for patients with suspected giant cell arteritis (GCA). While rare, it is critical not to miss, as delayed treatment can lead to significant complications including permanent visual loss. To date, little is known about the approach and challenges to diagnosis and management of GCA by GPs.
Objective:
To investigate the diagnosis and management of patients with suspected GCA in UK general practice.
Design And Participants:
A multimethods approach was taken, comprising a postal survey of 5000 randomly selected UK GPs and semistructured telephone interviews of 24 GPs from across the UK.
Setting:
UK general practice.
Results:
1249 questionnaires were returned. 879 responders (70%) indicated that they had diagnosed and managed a patient with GCA. A variety of clinical features were used to identify GCA. 21.9% suggested that they would exclude GCA as a diagnosis if headache was absent and around one-third do not routinely initiate glucocorticoid treatment prior to referral. Significant regional variations in referral pathways were reported. Thematic analysis of interview transcripts highlighted fears relating to a missed diagnosis of GCA and the non-specific nature of early GCA presentation. Accessing specialist care was highlighted as challenging by many GPs and that a national standard fast-track pathway is lacking to support this patient group. Additionally there were significant concerns regarding potential adverse effects relating to long-term treatment with glucocorticoids.
Conclusion:
GPs appear to over-rely on headache to identify GCA and marked geographical differences in management, with conflicting referral pathways and difficulties in accessing appropriate services exist in the UK. A national standard for fast-tracking patients with suspected GCA to relevant specialists would be beneficial to improve care and outcomes for patients with GCA.
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