Quality standards for the care of people with giant cell arteritis in secondary care

Giant cell arteritis (GCA) is the commonest primary systemic vasculitis in adults. It has significant health economic costs and societal burden (1, 2), which is likely to get worse with an aging population. British and European recommendations endorse early specialist review (3, 4). In England, 49% of centres provide a diagnostic ultrasonography service but there is wide variation in access and speed of delivery (5). 34% of hospitals in England did not have any formal clinical pathway for assessing GCA (5). Primary care physicians require pathways (6), and the experience of secondary care physicians suggests that establishing a robust one is difficult (5). Treatment recommendations provide an impetus for improvement in standards of care. Those with auditable metrics provide an even greater driver for change. For example, adoption of national standards for the treatment of early inflammatory arthritis in the United Kingdom has proven to be a significant catalyst for improvement in care (7). We have formed a multidisciplinary group aiming to create standards to bring about similar nationwide improvement in the care of GCA.