None listed
Conditions
Brief summary
Giant Cell Arteritis (GCA) is a condition of inflammation of blood vessels which commonly affects the blood supply to the eyes. Left undetected, GCA can rapidly cause irreversible blindness. Other potential complications include stroke, aortic dissection and death. Therefore, early diagnosis and intervention is imperative. Traditionally, diagnosis has relied on early suspicion of the disease, urgent review by a physician and an ophthalmologist, along with a surgical procedure (temporal artery biopsy). Following diagnosis of the disease, prompt treatment with potent immune suppressant medication is required. Biopsies are a relatively expensive procedure with a low positive yield. Additionally, biopsies can often take weeks to organise, but treatment needs to be given relatively urgently, so delay in obtaining biopsy means that diagnosis can be obscured by the treatment. Better ways of screening and managing patients are needed. Recently, international models of care have recommended an alternative approach to deliver assessment and care for GCA through “Fast Track” GCA Clinics, which have demonstrated improved outcomes for patients. These are collaborative clinics between rheumatologists and ophthalmologists that provide clinical review followed by assessment using ultrasound imaging of the arteries instead of biopsy. This approach avoids hospital admission but produces quick, accessible and reliable diagnostic yield and only a subgroup will require progression to biopsy. Fast Track GCA Clinics have not yet been implemented in the Australian health care setting. We aim to establish a collaborative Fast Track GCA Clinic in Western Australia and demonstrate direct health care savings, validity of ultrasound at the primary diagnostic tool over temporal artery biopsy, improved clinical outcomes for patients, and further the research agenda in this relatively common, potentially devastating, but treatable condition.
Interventions
This study aims to assess the effectiveness of a Fast Track Giant Cell Arteritis (GCA) Clinic in Western Australia, in terms of both health outcomes for patients and healthcare cost savings. Patients suspected of having GCA will be seen in the Fast Track Clinic (FTC) within approximately 72 hours of referral. The FTC will initially service the East and South Metropolitan Health Services of Western Australia. Patients will be assessed by a consultant rheumatologist during an approximately 60 minu
This study aims to assess the effectiveness of a Fast Track Giant Cell Arteritis (GCA) Clinic in Western Australia, in terms of both health outcomes for patients and healthcare cost savings. Patients suspected of having GCA will be seen in the Fast Track Clinic (FTC) within approximately 72 hours of referral. The FTC will initially service the East and South Metropolitan Health Services of Western Australia. Patients will be assessed by a consultant rheumatologist during an approximately 60 minute clinic appointment. This will include history, physical examination, questionnaires, blood tests, and ultrasound of the temporal, occipital, axillary +/- carotid arteries. Ultrasound is expected to take between 15 - 30 minutes depending on operator. All patients will then be seen by ophthalmology within one week for bilateral temporal artery biopsy. Full ophthalmological assessment will be performed more urgently if visual symptoms are present. The overall aim is to assess validity of ultrasound in replacing biopsy as the primary diagnostic investigation in GCA. If this approach is proven valid, costs will be deducted accordingly to demonstrate health care savings if biopsy were not routinely required. PET scan will also be organised for a subgroup of patients to assess burden of vasculitis at baseline and explore the relationship between GCA and cardiovascular events. Patients with confirmed GCA will be commenced or continued on treatment with corticosteroids as per the Australian Therapeutic Guidelines. There will be repeat appointments at the Fast Track Clinic at week 2, week 4, week 12, and week 24. At these visits, assessment will again include history, physical examination, ultrasound, blood tests, and questionnaires for patient reported outcomes. Repeat PET scan will be arranged at the 24 week appointment for the PET subgroup.
Sponsors
Royal Perth Hospital
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinical suspicion of giant cell arteritis, including but not limited to: new onset headaches / localised pain in the head, scalp tenderness, swelling over the temporal artery, pain over the temporal artery, jaw claudication, tongue claudication, reduced or lost vision, double vision and amaurosis fugax, anorexia, fatigue, fever/night sweats,
Exclusion criteria
Age under 50 years Unable to provide informed consent
Outcome results
None listed