Delays in recognition and management of giant cell arteritis: results from a retrospective audit
Delays in recognition and management of giant cell arteritis: results from a retrospective audit
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DOI：
10.1007/s10067-010-1616-y
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发表时间：
2011-02-01
影响因子：
3.4
通讯作者：
Dasgupta, Bhaskar
中科院分区：
文献类型：
--
作者：
Ezeonyeji, Amara N.;Borg, Frances A.;Dasgupta, Bhaskar
及时使用皮质类固醇 (CS) 可以预防巨细胞动脉炎 (GCA) 患者出现毁灭性的神经眼科并发症 (NOC)。 GCA 管理指南强调早期识别症状并及时治疗临床高度怀疑的疾病。本研究的目的是回顾 GCA 患者的临床结果，评估诊断和治疗的基线实践，并确定 NOC 患者治疗的延误。该研究对 2003 年至 2008 年间诊断为 GCA 的患者进行了回顾性病例记录审查。确定了 65 名患者（47 名女性，18 名男性，平均年龄 75 岁）。相当一部分患者出现全身症状、多肌痛症状和缺血症状。从症状出现到诊断出 GCA 的平均时间为 35 天。诊断为 GCA 的患者的 CS 并未延迟。对缺血症状的识别很慢。 16 名患者 (24.6%) 就诊时出现视力丧失。 10 名患者（15.4%）在没有头痛的情况下出现 NOC，其中 7 名（70%）出现永久性视力障碍。 5 名（7.7%）患者出现脑血管并发症。 GCA 的识别和治疗存在重大延误。不可逆缺血性并发症的发生率很高，部分原因可能是诊断和治疗延误造成的。
Prompt institution of corticosteroids (CS) can prevent devastating neuro-ophthalmic complications (NOC) in patients with giant cell arteritis (GCA). Guidelines on managing GCA place emphasis on early recognition of symptoms and prompt treatment of the disease where there is a high index of clinical suspicion. The aims of this study are to review the clinical findings in patients with GCA, evaluate the baseline practice in diagnosis and treatment and to identify delays in treating patients with NOC. The study utilised retrospective case notes review of patients diagnosed with GCA between 2003 and 2008. Sixty-five patients were identified (47 females, 18 males, mean age, 75 years). A significant minority presented with constitutional, polymyalgic and ischaemic symptoms. Mean time from symptom onset to diagnosis of GCA was 35 days. CS were not delayed in those diagnosed with GCA. Recognition of ischaemic symptoms was slow. Visual loss at presentation occurred in 16 patients (24.6%). Ten patients (15.4%) presented with NOC in the absence of headache, seven (70%) of whom developed permanent visual impairment. Five (7.7%) patients had cerebrovascular complications. There are major delays in the recognition and treatment of GCA. There is a high incidence of irreversible ischaemic complications which may partly result from diagnostic and treatment delay.