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Giant cell arteritis (GCA) presents to all specialties due to its early non-specific initial symptoms. As new-onset headache is one of the principal symptoms of cranial GCA, neurologists often assess (and indeed may manage) people with this condition, in isolation from rheumatology.
The British Society of Rheumatology, which has been accredited by the National Institute for Health and Care Excellence for guideline publication, recently updated their guideline for GCA. The previous version dated from 2010 was published before the routine use of ultrasound in GCA diagnosis and the advent of targeted immunotherapy treatment. The guideline group, including patients, methodologists and clinical experts in GCA, chose population, intervention comparator, and outcome questions to structure the systemic literature reviews. There were three broad reviews covering diagnostic imaging tests, management strategies and prognostic outcomes. The quality of evidence was assessed set out by Grading of Recommendations Assessment, Development and Evaluation methodology to underpin their recommendations.1 2
This article aims to highlight that neurologists require close liaison with rheumatology to serve patients with GCA best and may need to change their practice in light of these guidelines.
Recommendations for referral
Those suspected of having GCA should be assessed by a specialist, usually a rheumatologist, ideally on the same working day (where possible), and in all cases within …
Twitter Susan P Mollan @DrMollan.
Contributors SPM drafted and revised the script. SLM revised the script for intellectual content. Both read and approved the final manuscript.
Funding SLM receives infrastructure support from the MRC TARGET Partnership Grant (MR/N011775/1/MRC_/Medical Research Council/United Kingdom)
Competing interests SPM has received advisory board and speaker fees from Roche (2016–2019); speaker fees from Chugai-Roche Ltd (2017–2019) and advisory board fees from Janssen (2020). She has acted as an investigator on aclinical trial in GCA for Roche. SLM received consultancy fees from Roche (2015) and was supported by Roche to attend EULAR 2019. She has acted as an investigator on clinical trials in GCA for Sanofi, Roche and GSK. Consultancy fees from Roche (2016, 2018) and Sanofi (2017) were paid to her institution. She is Patron of the UK charity PMRGCAuk.
Patient consent for publication Not required.
Data sharing statement There is no unpublished data.
Provenance and peer review Not commissioned; externally peer reviewed Nicola Giffin, Bath, UK.