Audit of the management of suspected giant cell arteritis in a large teaching hospital.
BACKGROUND
The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high-dose corticosteroids may be associated with significant morbidity, including osteoporosis.


OBJECTIVE
To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital.


METHODS
We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteoporosis prophylaxis.


RESULTS
The mean waiting time for biopsy for all patients was 5.6 days (range 0-42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate.


CONCLUSIONS
There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis.
Dalbeth
N
N
Auckland Healthcare, University of Auckland, New Zealand. nicola.dalbeth@imm.ox.ac.uk
Lynch
N
N
McLean
L
L
McQueen
F
F
Zwi
J
J
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D009520:New Zealand; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control*; D011241:Prednisone / Q000009:adverse effects; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology
D000893:Anti-Inflammatory Agents; D011241:Prednisone; D008775:Methylprednisolone