216 Characteristics of patients with prevalent giant cell arteritis in UK primary care

Background: Giant cell arteritis (GCA) is a rare, but serious condition affecting older people. Prompt diagnosis remains challenging due to non-specific presentations. Furthermore, there are marked variations in GP referral and management approaches. Our aim was to characterise a prevalent GCA population, with specific objectives to examine general health, symptoms experienced pre- and post-diagnosis, treatments and their adverse-effects and comorbidities.Methods: This was a secondary analysis of a cross-sectional survey. 564 patients with prevalent GCA (defined as a GCA Read code in the three years’ pre-survey) aged over 50 from 300 English general practices were sent a baseline questionnaire. This examined demographic information, general physical and mental health (SF-12, physical component summary (PCS) and mental component summary (MCS) scores respectively), symptomatology, treatments, prednisolone adverse-effects and comorbidities. Descriptive statistics characterised the sample and comparisons were made between responders and non-responders and genders.Results: 318 patients with GCA responded to the survey (adjusted response rate=60%). Responders and non-responders were similar in age and gender. Mean age of responders was 73.7 (SD8.2) and approximately two-thirds were female with mean disease duration 2.7 (SD8.3) years. The prevalence of “classic” GCA symptoms were higher pre-diagnosis than at the point of the baseline survey, for example headache (86% vs 30%), scalp tenderness (57% vs 17%) and jaw claudication (45% vs 9%). 96% of patients had used prednisolone and 70% reported still taking it. Use of symptom-targeted medication, such as paracetamol was higher pre-diagnosis than at baseline (56% vs 31%), but use of preventative medications, such as bone protection was higher at baseline than pre-diagnosis (30% vs 13%). There was a high degree of steroid-related adverse-effects, with over half of responders reporting change in face shape, disturbed sleep, increased ease of bruising or weight gain. 35% stated they had, or would like to use alternative therapies (e.g. acupuncture). The most commonly reported comorbidities were cardiovascular, 52% reported hypercholesterolemia and 40% hypertension. Though PCS (41.5 vs 38.1) and MCS scores (46.7 vs 45.9) similar in men and women, these were all lower than population norms.Conclusion: Patients with a prevalent diagnosis of GCA continue to report symptoms despite treatment, and reported physical and mental health is worse than in general populations. This suggests that either current treatment is not entirely effective or there may be alternative underlying causes for symptoms which may pose challenges to assessment of relapse. Glucocorticoid-related adverse effects are frequently reported and their prevention increases the polypharmacy associated with this condition. Patients’ pursuit of alternative treatment methods, several years after diagnosis, suggests dissatisfaction with current treatment. These findings highlight the need for holistic care to support the general health of this patient group and reinforces the necessity for continued research into new treatments