AB1316 GIANT CELL ARTERITIS CARE IN ENGLAND AND WALES: FIRST DATA FROM THE UPDATED NATIONAL EARLY INFLAMMATORY ARTHRITIS AUDIT (2024)

Abstract

Background: Giant Cell Arteritis (GCA) is a large vessel vasculitis associated with severe morbidity and requiring prompt assessment and treatment. The National Early Inflammatory Arthritis Audit (NEIAA) is a mandated audit of rheumatology care in England and Wales. In April 2023 GCA was added to the list of conditions included in NEIAA to characterise variation in care quality.

Objectives: We describe the characteristics of people with GCA enrolled in NEIAA including age, gender, ethnicity and work status. We report data on indicators of disease status and care quality: time from referral to rheumatology assessment, time to diagnosis and symptom duration at first review. These data are compared against patients with rheumatoid arthritis (RA).

Methods: We obtained NEIAA data for GCA and RA patients enrolled from April to November 2023. We used descriptive statistics (counts/percentages, medians/interquartile ranges [IQRs], means/standard deviations [sd]) to summarise the characteristics of each diagnostic group: age, gender, ethnicity (Asian, black, mixed, other or white), and work status (in paid work >20 hours per week or not). The primary outcome was time from referral to rheumatology assessment. Secondary outcomes were time from referral to diagnosis and patient reported duration of symptoms prior to assessment (<1 month, 1-3 months or >3months). The number of patients with GCA assessed within 1 day and within 3 days were reported. Patient numbers of less than 5 were redacted to reduce the risk of identification via small counts.

Results: 2308 patients were recruited (61 with GCA [2.6%], 2223 with RA [96%]); (Table 1). GCA patients were older (median 76 years, IQR [69,81]; 8% of patients <60 years) than RA,(median 61, IQR[50,71]; 49% of patients <60). GCA patients were more likely to be female (69% vs 64%) and white (97% vs 80%), and less likely to be in work (20% vs 45%). Time to assessment was shorter for GCA (median 6 days, IQR [2,15]; mean 14 days, sd 19) than for RA (median 18 days, IQR [11,23]); mean 28 days, sd 34). 6 GCA patients (10%) were assessed by rheumatology within 1 day of referral, and 20 patients (33%) within 3 days. Figure 1 shows the more prompt assessment of GCA patients compared to RA, but also that a small proportion of GCA patients wait longer than 30 days for review. GCA patients experienced less delay from referral to diagnosis (mean 16 days, sd 33; median 7, IQR [1,21] against 36 days, sd 116, for RA [median 27, IQR {15,47}]. People with GCA typically reported shorter duration of symptoms (52% had symptoms <1 month) than those with RA (8%).

Conclusion: Enrolment of GCA patients into NEIAA has commenced, with evidence of uptake amongst many clinicians. Recruitment rates are less than expected for the estimated incidence of the condition in the UK, perhaps reflecting lack of awareness of the new requirements for data entry. The patient demographic broadly reflects the known epidemiology of GCA, though fewer non-white patients are present in this small cohort than might be expected. Times to assessment and diagnosis of GCA were shorter than for RA, likely indicating prioritisation of patients with possible GCA symptoms. However, on average these times are still longer than is desirable in the management of a potentially sight-threatening condition. This may reflect delayed outpatient assessment of patients managed initially in hospital, inadequate referral triage or high service pressures. Substantial numbers of patients report prolonged symptoms, suggesting limited public awareness of GCA, difficulty accessing healthcare, or delayed referral from primary care. Our findings offer a reminder to maintain robust GCA pathways and to audit performance robustly to bolster our understanding of patient care.

Acknowledgements: NIL.

Disclosure of Interests: Edward Alveyn: None declared, Sarah Mackie Support from Roche/Chugai to attend EULAR2019 in person and from Pfizer to attend ACR Convergence 2021 virtually. SLM is supported in part by the NIHR Leeds Biomedical Research Centre. The views expressed in this article are those of the authors and not necessarily those of the NIHR, the NIHR Leeds Biomedical Research Centre, the National Health Service or the UK Department of Health and Social Care., Max Yates Advisory board work for BioGen, Financial support from AbbVie and UCB to attend international conferences., James Galloway JG has received honoraria from AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB., JG has received honoraria from AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB.