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      Empfehlungen für die interdisziplinäre Betreuung von Patienten mit Riesenzellarteriitis: «Giant Cell Arteritis Hospital Quality Standards» (GHOST)

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      Kompass Ophthalmologie
      S. Karger AG
      GCA, large vessel vasculitis, quality standards, pathways

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          Abstract

          Objective: GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services. Methods: The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement. Results: 13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise.

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          Most cited references9

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          Ophthalmic manifestations of giant cell arteritis

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            British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary

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              Is Open Access

              Health-related quality of life in patients with giant cell arteritis treated with tocilizumab in a phase 3 randomised controlled trial

              Background Patients with giant cell arteritis (GCA) treated with tocilizumab (TCZ) every week or every other week and prednisone tapering achieved superior rates of sustained remission to patients treated with placebo and prednisone tapering in a randomised controlled trial. Health-related quality of life (HRQOL) in patients from this trial is now reported. Methods Exploratory analyses of SF-36 PCS and MCS and domain scores, PtGA and FACIT-Fatigue were performed in patients treated with weekly subcutaneous TCZ 162 mg plus 26-week prednisone taper (TCZ-QW + Pred-26) or placebo plus 26-week or 52-week prednisone tapers (PBO + Pred-26 or PBO + Pred-52). These analyses were performed on responder and non-responder patients, including those who achieved the primary outcome and those who experienced flare and received escape prednisone doses. Results Baseline SF-36 PCS, MCS and domain scores were low, indicating impaired HRQOL related to GCA. At week 52, least squares mean (LSM) changes in PCS scores improved with TCZ-QW + Pred-26 but worsened in both PBO + Pred groups (p <  0.001). LSM changes in MCS scores increased with TCZ-QW + Pred-26 versus PBO + Pred-52 (p < 0.001). Treatment with TCZ-QW + Pred-26 resulted in significantly greater improvement in four of eight SF-36 domains compared with PBO + Pred-26 and six of eight domains compared with PBO + Pred-52 (p < 0.01). Improvement with TCZ-QW + Pred-26 met or exceeded minimum clinically important differences (MCID) in all eight domains compared with five domains with PBO + Pred-26 and none with PBO + Pred-52. Domain scores in the TCZ-QW + Pred-26 group at week 52 met or exceeded age- and gender-matched normative values (A/G norms). LSM changes from baseline in FACIT-Fatigue scores increased significantly with TCZ-QW + Pred-26, exceeding MCID and A/G norms (p < 0.001). Conclusions Patients with GCA receiving TCZ-QW + Pred-26 reported statistically significant and clinically meaningful improvement in SF-36 and FACIT-Fatigue scores compared with those receiving prednisone only. Improvements in the TCZ-QW + Pred-26 group led to recovery of HRQOL to levels at least comparable to those of A/G-matched normative values at week 52 and exceeded normative values in five of eight domains. Trial registration ClinicalTrials.gov, NCT01791153. Date of registration: February 13, 2013.
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                Author and article information

                Journal
                KOP
                10.1159/issn.2297-0118
                Kompass Ophthalmologie
                Kompass Ophthalmol
                S. Karger AG
                2297-0118
                2297-0045
                2023
                27 October 2023
                : 9
                : 4
                : 151-154
                Affiliations
                Augenzentrum, Pallas Klinik, Olten, Schweiz, Klinik für Augenheilkunde, Universitätsklinikum Duisburg-Essen, Essen, Deutschland, Medizinische Fakultät, Bern, Schweiz
                Article
                534264 Kompass Ophthalmol 2023;9:151–153
                10.1159/000534264
                4bec6eb1-1eca-431c-925b-0ef956eb15bc
                © 2023 S. Karger GmbH, Freiburg

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

                History
                Page count
                Pages: 4
                Categories
                Wissenstransfer

                Medicine
                large vessel vasculitis,quality standards,pathways,GCA
                Medicine
                large vessel vasculitis, quality standards, pathways, GCA

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