Background/Purpose: The rate of positive temporal artery biopsies (TAB) in patients with suspected giant cell arteritis (GCA) varies widely, indicating the need for better pre-test probability evaluation. The Southend Probability Score (GCAPS) has been developed as a GCA risk stratification tool and low scores ( < 10), can exclude the diagnosis without the need for further investigation. It has not been studied in ophthalmology specific hospitals, where patients may present with a higher frequency of ophthalmic symptoms and have a greater risk of vision loss if the diagnosis is missed.

Methods: Medical records of patients who underwent temporal artery biopsy (TAB) between 2010-2020 at the quaternary Sydney and Sydney Eye Hospital (SSEH) and 2010-2017 at the tertiary Prince of Wales Hospital (POWH) were reviewed and stratified into low (score < 10), intermediate (score 10-12) and high risk (score ≥13) according to the GCAPS score.

Results: Two hundred and thirty-three patients were assessed: 160 from SSEH and 73 from POWH. All 39 patients classified as low-risk had a negative TAB result (table 1). Amongst low-risk patients, the most reported symptoms were headache (69.2%) and cranial ischemia (38.5%), which included jaw claudication, transient monocular vision disturbance and diplopia. The most frequently noted examination findings were temporal artery abnormalities (15.4%) and isolated relative-afferent pupillary defect (5.1%). None of the low-risk patients had findings consistent with arteritic anterior ischemic optic neuropathy.

Conclusion: The GCAPS reliably predicted negative biopsy results in all patients with a low-risk score. This study supports its use as a risk stratification tool in both ophthalmological and general medical settings and help to exclude the diagnosis and need for temporal artery biopsy in patients with GCAPS of less than 10.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-use-of-the-southend-gca-probability-score-gcaps-in-assessing-the-risk-of-giant-cell-arteritis-in-australian-ophthalmological-and-general-medical-hospital-cohorts/