Background:
Giant Cell Arteritis (GCA) is the most frequent form of vasculitis affecting patients over the age of 50. Visual complications are the most feared outcome of GCA, the most devastating result being complete blindness. However, early diagnosis and treatment with long term corticosteroids can prevent these complications. Treatment carries a high burden serious adverse effects and it is crucial that the diagnosis is made with certainty. The gold standard of diagnosis of GCA is confirmation by timely temporal artery biopsy (TAB).
Methods:
We performed a retrospective review of all TAB submitted to the Pathology North database between January 5, 2012 and July 20, 2016. There were a total of 104 biopsies, of which 94 were analysed from patient medical records. There were 21 positive, 65 negative, and 8 indeterminate biopsies. The areas of interest included admission length, time to corticosteroid therapy and TAB, symptom duration, and visual complications.
Results:
The mean admission length for all patients was 6.95 days (range 0-81), including 11.5, 6.09 , and 3.14 days for positive, negative and indeterminate biopsies, respectively. All patients with positive and indeterminate biopsies were on corticosteroids at time of biopsy, as well as the majority of patients with negative biopsies (95.3%). The average length on corticosteroids was 5.17, 8.37 and 12 days for positive, negative and indeterminate biopsies, respectively. In total, there were 12 (6.4%) patients with permanent visual impairment.
Conclusions:
This audit highlighted several areas of improvement, including streamlining the process of obtaining TAB and lengthy inpatient admission.