Improving care for patients with giant cell arteritis

A specialist service for patients with an acute inflammatory disease has shared its ten year quality improvement journey in a national medical journal.

In 2009, just 27 patients were diagnosed with giant cell arteritis (GCA) at the Norfolk and Norwich University Hospital and received no formal education about their condition or their treatment.

Today, the dedicated GCA clinic at the hospital receives more than 130 referrals a year, has saved the NHS more than £140,000 a year by diagnosing the majority of cases by ultrasound instead of biopsies and provides more support to patients with a vasculitis nurse-led outpatient service.

The disease is caused by inflammation of the arteries of the head and neck and requires urgent treatment with a course of steroids.

Dr Chetan Mukhtyar, consultant rheumatologist at NNUH, co-authored a report in the Clinical Medicine Journal, which is published by the Royal College of Physicians.

He said that prior to the formation of a dedicated GCA clinic, patients were not always referred to hospital for diagnosis and treatment plans.

“We have much more GCA in East Anglia and 20% more than other regions of the UK. We think Scandinavian genetics is one of the biggest reasons this is the case. Iceland, Norway and Sweden have a lot of GCA in their countries. The fact we have more elderly people in Norfolk and the risk of GCA increases with age is also a factor.”

“Prevalence of the disease has not increased, but now there is a dedicated service that is trusted by clinicians in the hospital and other departments and by GPs, patients are coming to the right place for diagnosis and treatment. We have become a pioneering centre for treating GCA.”
Dr Mukhtyar said the funding of an ultrasonography machine by the N&N Hospitals Charity had made the service more cost-effective by reducing the need to carry out more costly and invasive biopsies to diagnose the condition.

He added that patients were now empowered with the appointment of a specialist nurse, which means that each patient has regular contact with an outpatient clinic and time to discuss the management of their condition in detail. The service was a finalist in the Royal College of Physicians’ Excellence in Patient Care Awards last year.

“It is an evolving and growing service and GCA is one of a number of vasculitis conditions, which falls under rheumatology, but involves clinicians from a range of other specialities. We are a beacon service in the East of England and helping patients across the region,” said Dr Mukhtyar.

The main symptoms of GCA are:

•           frequent, severe headaches

•           pain and tenderness over the temples

•           jaw pain while eating or talking

•           vision problems, such as double vision or loss of vision in one or both eyes

GCA can lead to serious problems like stroke and blindness if not treated quickly. Please contact NHS 111 who will advise you want to do.