LAUSR

All ophthalmologists are aware that giant cell arteritis (GCA) is a major cause of sudden permanent loss of vision. However, the diagnosis and management of GCA can be challenging in the busy eye out-patient clinic. GCA poses some major difficulties, even for the experienced clinician. The clinical history may be non-specific, with the onset of symptoms being insidious [1]. Furthermore, those with cranial GCA may report no systemic symptoms (the true occult GCA) [2]. Immediate investigations can be conflicting, particularly as inflammatory markers are nonspecific and may be low to normal in cranial only disease [3, 4]. Arranging a temporal artery biopsy (TAB) promptly may not be easy and interpretation is not always straightforward [5, 6]. Finally managing the patient long-term on glucocorticoids, particularly in the face of co-morbid disease or glucocorticoid-induced diabetes and hypertension, can be difficult [7]. There have been major developments in GCA [1, 8] and now as a nation we are investigating more suspected GCA annually [9]. The British Society of Rheumatology (BSR) have published timely guidance [10, 11] to reflect these advances following their previous guideline [12] and they recommend a change to our routine clinical practice. The BSR is accredited by the National Institute for Health and Care Excellence, and commissioned this update in 2014. The guideline group involved patients, methodologists and experts in GCA, from rheumatology, ophthalmology and primary care. They developed population, intervention comparator, and outcome questions to form the basis of three systemic literature reviews (SLR). The SLRs covered 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 [13].