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Coventry fast track pathway for managing giant cell arteritis

Shirish Dubey, Jonathan Pinnell, Carl Tiivas & Purnima Mehta

Giant cell arteritis (GCA) is the commonest form of vasculitis seen in United Kingdom (UK). It usually presents with new onset headaches, scalp tenderness, jaw claudication or visual symptoms – acute visual loss is a catastrophic presentation and complication of untreated GCA. Hence, it is treated as a medical emergency. Most units have a protocol for assessing these patients and treating these patients promptly – usually this involves the general practitioner GP) starting steroids and sending the patient to secondary care for further evaluation. Recent utility of vascular Doppler ultrasound (US) has allowed many units to develop a fast track pathway for assessing and managing these patients. Coventry established its walk-in fast track pathway which included clinical assessment with rheumatology and/or ophthalmology along with US in 2013. Patients were normally seen within a few hours of referral and the pathway is unique in not needing GPs to start steroids in advance of their assessment in secondary care. This article describes the rationale for the way the pathway was designed and also describes the results of the initial pilot phase of this pathway.