Background/Purpose: Expedited referral systems or “fast-track” clinics incorporating vasculitis ultrasound (VUS) into the evaluation of patients with suspected giant cell arteritis (GCA) have shown reduced complications, such as blindness and inappropriate use of prednisone. EULAR guidelines recommend VUS as an initial diagnostic modality in GCA. The use of VUS for GCA diagnosis in the United States has been limited to date. We report the current state of fast-track clinics that include VUS in the diagnosis of GCA at several academic institutions and 1 large private practice in the United States, on behalf of USSONAR.

Methods: A 31‐item survey questionnaire was sent via Qualtrics^® to the lead clinic director of 6 practices using VUS in the diagnosis of GCA within an expedited referral system. The survey included 31 questions (Qs) with the following domains: 1) general identifying data (3 Qs), 2) clinical evaluation of GCA patients (3 Qs), 3) VUS utilization, acquisition, interpretation (8 Qs), 4) interdisciplinary collaboration (4 Qs), 5) systems-based effectiveness; support for GCA referral system (9 Qs), 6) utilization of other imaging modalities (4 Qs).

Results: Survey respondents included 5 academic institutions: Massachusetts General Hospital (MGH), University of Washington (UW), Brigham and Women’s Hospital (BWH), Loma Linda University (LLU), and University of California-Los Angeles (UCLA); and 1 large private practice Arthritis and Rheumatism Associates PC, Wheaton MD (ARA). VUS acquisition and interpretation varied by institution. At 2 centers (MGH, UCLA), VUS images were obtained and interpreted by a vasculitis specialist. At 3 centers (MGH, LLU, ARA), a vasculitis specialist referred patients to a VUS-trained rheumatologist for acquisition and interpretation. At 2 centers (UW, BWH), vasculitis specialists referred patients to US technicians trained in VUS; images were interpreted by a vascular surgeon with verification by a VUS-trained rheumatologist (UW), or a vascular medicine specialist (BWH). VUS evaluation for GCA occurred within 48 hours at all centers. The majority of referred patients had clinically high suspicion of GCA; some referrals were deemed inappropriate, e.g. headache only. A multidisciplinary collaborative approach to the evaluation and management of LVV was employed by most centers; EM, ENT, neurology, and plastic, vascular and general surgery were the most common collaborators. Three institutions co-led the expedited referral system with primary care or one or more specialties. Most rheumatologists managed the cases post-diagnosis, except for one institution (LLU) where there was co-management with ophthalmology. Additional imaging was utilized in some cases despite a positive VUS to ascertain other non-cranial large-vessel involvement and possible inclusion in clinical research (MGH, ARA). A temporal artery biopsy was obtained if VUS was positive (UCLA, LLU), or negative/indeterminate based on clinical scenario (ARA, UW, BWH, MGH).

Conclusion: VUS in GCA is currently implemented in different ways in few institutions in the United States. There is a need for further training and systems-based changes to support the development of fast-track clinics in the United States.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-current-state-of-expedited-referral-systems-incorporating-vasculitis-ultrasound-for-the-diagnosis-of-giant-cell-arteritis-in-rheumatology-practices-in-the-united-states/