As a rheumatologist working in the Kaye Clinic, Dr. Clifford sees many patients with vasculitis, a group of disorders that causes inflammation of blood vessels. This includes giant cell arteritis (GCA), the most common type of vasculitis in North America, which affects the large blood vessels in the body, including the largest one, the aorta.
If left untreated, GCA can cause serious complications like a stroke or blindness, so starting treatment quickly is key to preventing long-term damage. Unfortunately, diagnosing it can be difficult. Dr. Clifford’s quality improvement project, funded by the Kaye Competition, will help change that.
“The tricky part about GCA is that patients can present with all kinds of symptoms, many of which are common. It can be a hard disease to recognize and a hard disease to prove because there are no blood tests that can confirm it. We usually need several tests – including a biopsy of one of the arteries of the scalp and imaging of the blood vessels with a PET scan – to help confirm the diagnosis. These tests are good, but they take time to arrange and interpret,” says Dr. Clifford.
The ultimate goal is to see the patients as soon as possible and decide early who needs treatment with prednisone and who doesn’t. Prednisone works well in GCA, but it doesn’t come without side effects. So it’s ideal if GCA can be ruled out at an early stage and those patients who won’t benefit from prednisone can avoid it and its complications.
“In other parts of the world, temporal artery ultrasound has become the standard of care. When you see a rheumatologist, they put an ultrasound probe on the scalp arteries in the office, and can see whether there is inflammation present or not. This helps stratify right away if there’s a high risk or low risk of this disease,” Dr. Clifford says.
Inspired by this approach to diagnosing GCA, Dr. Clifford developed a quality improvement project that has three main phases:
This includes looking at what testing is done, how long it takes to get diagnosed, and how much prednisone is given before diagnosis. Patients will also be surveyed to share how they have felt through the process of multiple appointments and tests.
Once the ultrasound machine is purchased and installed, the training on vascular ultrasound can ramp up and get Dr. Clifford ready to use it on patients.
This pilot project will allow healthcare providers to send suspected GCA patients to be assessed at this fast-track clinic. In addition to the usual testing, patients will have a vascular ultrasound done. Doing full testing in the early stages of this clinic will help Dr. Clifford compare the ultrasound findings against the other testing methods to see how many of the patients that have GCA could’ve been diagnosed early by ultrasound alone, and how many that don’t have GCA could have avoided prednisone or additional testing.
“This project and the purchase of this ultrasound would not be possible without the Kaye Competition funding. I hope that this project will help us diagnose GCA in patients faster to reduce the risk of stroke and vision loss, and will help us limit prednisone exposure in those without the disease. I also hope it’s an easier process for the patients — if they can have one appointment early on that includes both a clinical assessment and a diagnostic test,” says Dr. Clifford.