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The importance of ensuring prompt diagnosis of Giant Cell Arteritis

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    Sophia Courtaux writes about a condition called giant cell arteritis which is reported to damage the sight of about 3,000 patients every year in the UK, and steps that have been taken by the NHS to ensure prompt diagnosis of the condition and limit sight loss.

    By Sophia Courtaux

I came across an article on the health news section of the BBC website on a condition called Giant Cell Arteritis (GCA), a condition that can quickly cause loss of vision if not diagnosed and treated, and this prompted me to find out more about it.

What is GCA?

GCA occurs when arteries in the head and neck become inflamed and giant cells accumulate in the artery walls. One of the arteries commonly affected provides blood to the optic nerve, which transmits information from the retina to the brain. Blocking the nerve and starving it of blood can lead to permanent blindness.

What are the signs and symptoms of GCA?

The National Institute of Health Care and Excellence (NICE) have published a ‘Clinical Knowledge Summary’ on GCA, to provide medical practitioners in primary care, such as GPs, with a summary of practical guidance and best practice on diagnosis and management.

The guidance notes that GCA tends to affect adults over 50 and is three times more common in women than in men. It’s also seven times more common in white people than in black or Asian people.

Symptoms include:

  • Localised headaches;
  • Scalp tenderness (brushing hair is painful);
  • Pain in the jaw when eating;
  • Systemic features such as fever, fatigue, anorexia, weight loss, and depression;
  • Features of polymyalgia rheumatic (PMR) (bilateral upper arm stiffness, aching, and tenderness; pelvic girdle pain);
  • Visual disturbances;
  • Neurological features (for example mononeuropathy or polyneuropathy of arms or legs, transient ischaemic attack, stroke);
  • Peripheral arthritis and distal swelling with pitting oedema;
  • Respiratory tract symptoms such as cough, sore throat, and hoarseness.

The symptoms of GCA usually develop quickly but there may be earlier warning signs such as weight loss, day and night sweats, tiredness, mild fever, loss of appetite and depression as above. The window of treatment is small – in some cases, sight can be lost within days or even hours. The only thing that can save it is immediate treatment with steroids and the window of opportunity for this treatment can be short.

What can the NHS do to reduce the number of people losing their sight from GCA?

In the last couple of years a new ‘fast track system’ has been set up to try and make sure this condition, if suspected, is diagnosed as quickly as possible. In some parts of the UK there are now dedicated phone lines so GPs can get their patients an appointment with a Rheumatologist within 24 hours when GCA is suspected. Anyone at risk is then screened using ultrasound – if a patient has GCA, the scan will reveal a dark band, known as the halo sign, around the temporal artery and treatment can be given.

The fast track system was pioneered by doctors at Southend University Hospital in 2013, and they reported that the number of patients suffering full or partial sight loss reduced from 17 to 1 patient in the year following the trial of this system. This is of course a positive step towards reducing the amount of people losing their sight to this devastating condition.

My colleagues and I in the Clinical Negligence Team often see cases where our clients have suffered from a delay in diagnosis due to negligent failings in their medical treatment. This is an example of where a simple system can ensure patients are assessed and treated quickly to prevent or limit severe consequences such as sight loss. It is imperative that there is awareness of symptoms of GCA by both patients and doctors and one would hope that this fast track system is introduced nationwide to help prevent further unnecessary sight loss.

 

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