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Pioneering pathway acts fast to reverse sight loss

01 March 2016

Health Care

Southend Hospital is leading the way in treatment, education and raising awareness of potentially irreversible sight loss condition.

  • Southend Hospital's rheumatology department awarded Outstanding Best practice award for pioneering work in treating giant cell arteritis, a potentially devastating sight loss condition
  •  Roger Keay, 77, had his sight saved thanks to fast-track pathway at Southend Hospital
  •  Southend Hospital playing a key role in educating GPs and those at risk of sight loss

Roger's story

Roger Keay (right), 77, from Thorpe Bay has always been active and healthy, taking up many sports including scuba diving, skiing and golf. Roger is rarely ill. 

But last September Roger began experiencing flu-like symptoms accompanied by terrible night sweats and for two months he generally felt poorly. But when the vision in his right eye started to look like he was looking through fog, Roger realised something serious must be wrong. Roger was on the verge of going irreversibly blind in his right eye.

"It was quite out of the blue and it frightened the life out of me," admits Roger. "I have always had excellent eyesight; I used to read the names of the ships on the estuary. I know eyesight deteriorates with age but the thought of losing my eyesight frightens the life out of me." 

Unsure exactly what the problem was, Roger's GP referred him to Southend Hospital where an eye specialist made the immediate diagnosis of giant cell arteritis (GCA), an easily treated but often missed condition that needlessly claims the sight of some 2,400 mainly elderly people every year.

GCA is a condition in which medium and large arteries, usually in the head and neck, become inflamed. It's sometimes called temporal arteritis because the arteries around the temples are usually affected.

Before the official diagnosis could be made, Roger was immediately put on a steroid infusion because no time can be wasted. Not everyone is as fortunate as Roger and some have lost their sight in one eye, and in some cases, both eyes due to a devastating lack of awareness amongst health professionals.

Southend Hospital leading the way for treatment of GCA

Roger was now a patient on the Southend Hospital fast-track pathway developed by Professor Bhaskar Dasgupta and his rheumatology department which ensures rapid specialist review and treatment of patients with suspected GCA.

The rheumatology department at Southend University Hospital have recently been awarded the Outstanding Best Practice Award 2015-16 in Rheumatology and Musculoskeletal Health by The British Society for Rheumatology (BSR).

Professor Dasgupta, who developed the fast-track pathway, said: "The pathway significantly reduces irreversible sight loss. This award means it's now going to have national backing from the BSR for them to take it forward with commissioning authorities so that this pathway is rolled out across the country and perhaps at some point across the globe to benefit all patients. It is one of the main culminations of all the hard work and research that we have done." 

Education is key - 'Time is Sight'

One of the highlights of the pathway is the primary care education and training that the department are doing through the GP  clinical commissioning group 'Time to Learn' sessions held at Saxon Hall on Tuesday afternoons. GPs are invited to these sessions and are taught how to recognise early signs of GCA.

"We want to ensure early recognition of GCA becomes enshrined in GP training and education," said Professor Dasgupta. "It's like the 'Act FAST' stroke campaign which raises public and professional awareness of early stroke prevention. The stroke pathway uses the slogan 'Time is Brain' but we are using the slogan 'Time is Sight'. If you can get people on to treatment quickly, you can prevent sight loss."

Recognising the symptoms

If doctors recognise the symptoms, the outcome can be so different. Hannah Padbury, from Southend, runs the local Polymyalgia Rheumatica & Giant Cell Arteritis UK group, the charity which campaigns for people with the condition.

When she herself developed a stiff jaw and eye problems, her GCA was diagnosed quickly by Southend Hospital's rheumatology department and she was given steroid infusions.

Hannah and the group are playing a crucial role in raising awareness of GCA to the public and those at risk of developing it.

"I actually diagnosed my sister in law," Hannah admits. "She thought she had polymyalgia but her symptoms were typical of GCA. It was only through my experiences with GCA and working with professor Dasgupta that I knew about this. Before this pathway, people were losing their sight either because it wasn't diagnosed by their GP and not referred to rheumatology. If you have any doubts about what is happening to you then you must go straight to A&E.  Not everywhere have a fast-track service so we are very lucky in Southend."

Symptoms of giant cell arteritis include:

  • aching and soreness in and around the temples
  • jaw muscle pain while eating
  • vision loss
  • polymyalgia ,an aching and stiffness in both shoulders and thighs
  • accompanied by weight loss, night sweats, anemia, tiredness
  • raised inflammatory markers such as ESR and CRP

These can often develop suddenly, but may follow vague symptoms such as weight loss and prolonged tiredness. The diagnosis can be quickly confirmed with the use of temporal artery ultrasound available in the clinic or by urgent temporal artery biopsy.

Roger is a 'very lucky man'

Roger is an amazing statement of the benefit of Professor Dasgupta's fast-track pathway. He had a lot of the symptoms and he was immediately treated and his sight loss was reversed.

Roger said: "I asked Professor Dasgupta if I will go blind eventually because of GCA and he said '100% guaranteed that we have stopped the problem'. I've lost some field of vision but it's not a problem, I still drive, play golf, ride my bike. I'm still doing everything I used to. If it wasn't for this treatment I would now be blind.  I said to Professor Dasgupta I can't thank you enough, if I was a millionaire I'd give you a million pounds. Professor Dasgupta said to me 'you're a very lucky man and I thought 'tell me about it'."

Facts about GCA

  • In the UK, it's estimated about 1 in every 4,500 people will develop giant cell arteritis each year.
  • It only tends to affect adults over the age of 50, and those who develop the condition are usually over 60.
  • Giant cell arteritis is three times more common in women than in men. It's also seven times more common in white people than in black people.