A Tale of Diagnostic Delay with Detrimental Consequences: Illustrating the Challenging Nature of Diagnosing Giant Cell Arteritis

  • Marieke van Nieuwland Department of Rheumatology and Clinical Immunology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo, The Netherlands https://orcid.org/0000-0002-2188-6117
  • Dennis Boumans Department of Rheumatology and Clinical Immunology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo, The Netherlands
  • Gerben Jan Jacob Plas Department of Neurology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo, The Netherlands https://orcid.org/0000-0003-3032-6338
  • Onno Dirk Vijlbrief Department of Radiology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo, The Netherlands https://orcid.org/0000-0003-2303-6009
  • Celina Alves Department of Rheumatology and Clinical Immunology, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo, The Netherlands https://orcid.org/0000-0003-3498-8507

Keywords

Giant cell arteritis, diagnostic delay, severe complications

Abstract

Giant cell arteritis is a medical emergency as severe, irreversible complications may occur if it is not treated in a timely manner. However, in daily practice early diagnosis can be challenging. We report the case of a 70-year-old woman who presented with multiple ischaemic cerebral vascular accidents related to newly diagnosed giant cell arteritis. Review of her charts revealed a substantial delay from the onset of symptoms to diagnosis. This case demonstrates the need for additional efforts to reduce delay in referring patients with giant cell arteritis and the need to implement fast-track clinics to prevent serious complications.

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References

  • Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77(5):636–643.
  • Schäfer VS, Juche A, Ramiro S, Krause A, Schmidt WA. Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis. Rheumatology 2017;56(9):1479–1483.
  • Baig IF, Pascoe AR, Kini A, Lee AG. Giant cell arteritis: early diagnosis is key. Eye Brain 2019;11:1–12.
  • Prior JA, Ranjbar H, Belcher J, Mackie SL, Helliwell T, Liddle J, et al. Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis. BMC Med 2017;15(1):120.
  • Diamantopoulos AP, Haugeberg G, Lindland A, Myklebust G. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? Rheumatology 2016;55(1):66–70.
  • Luqmani R, Lee E, Singh S, Gillett M, Schmidt WA, Bradburn M, et al. The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of giant cell arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016;20(90):1–238.
  • Published: 2021-07-27

    Issue: 2021: Vol 8 No 7 (view)

    Section: Articles

    How to cite:
    1.
    van Nieuwland M, Dennis Boumans, Gerben Jan Jacob Plas, Onno Dirk Vijlbrief, Celina Alves. A Tale of Diagnostic Delay with Detrimental Consequences: Illustrating the Challenging Nature of Diagnosing Giant Cell Arteritis. EJCRIM 2021;8 doi:10.12890/2021_002562.