Consultant rheumatologist/AAU physician, Hawkes Bay DHB
Audit Of Temporal Artery Biopsies Done At HBDHB Over 2 Time Periods.
Aims: To review all temporal artery biopsies done at Hawke’s Bay DHB between the periods of September 2013-September 2014 and again August 2016-August 2017 and review each case with reference to the published BSR Guidelines for the management of giant cell arteritis.
Methods: Giant cell arteritis is the commonest of the vasculitides encountered and given its plethora of symptomatology patients are often first seen by general physicians. I obtained all temporal artery biopsies done between September 2013-September 2014 from laboratory data (N=33) and reviewed case notes for patient presenting symptoms, temporal artery biopsy positivity, length of specimen, timeframe until biopsy, referral source, initial treatment, level of inflammatory markers and subsequent follow-up. I repeated the audit for the period of September 2016-September 2017 (N=26). I compared management with published BSR guidelines for the management of giant cell arteritis. I am interested in reasons for delays in biopsy and pathways to obtain biopsy.
Results: There were 33 biopsies in the first audit and 26 biopsies in the second audit. Biopsy positivity in the two audits and was in keeping with published data (20%). Biopsies were almost exclusively done by Surgical Registrars. The length of biopsy was variable with 1 failed biopsies. There was a large variation in timeframe between request and subsequent biopsy with some themes related to this being apparent. Patients appeared to be appropriately commenced on treatment when GCA was considered. The majority of follow-up was through Rheumatology Clinic. There was only one positive biopsy with normal inflammatory markers.
Conclusions: There was variation in how patients ended up obtaining a temporal artery biopsy and this variation did reflect in delays in biopsy. Prior to the first audit there was not a consistent pathway for temporal artery biopsies and this was established prior to the subsequent audit. Generally HBDHB management of giant cell arteritis is in keeping with published guidelines.
References: Rheumatology 2010; 49; 1594-1597.