OBJECTIVES: Giant Cell Arteritis (GCA) remains a challenge both in terms of diagnosis and management as patients may present to several different specialists. The objectives were to determine incidence of biopsy-proven GCA in Malta and to compare the management between rheumatologists and nonrheumatologists. METHODS: This was a retrospective observational population study of patients with suspected GCA who underwent a temporal artery biopsy (TAB) between 2012 and 2015. Data collected consisted of demographics, presenting symptoms, TAB histology reports, treatment and outcome. The British Society for Rheumatology (BSR) 2010 guidelines were used as standard of care. RESULTS: 136 patients underwent a TAB for suspected GCA of which 26 were positive. The incidence of biopsy-proven GCA in Malta was 3.82 per 100,000 patient years in the over 50 population. There were 63 patients who were treated as GCA. Only 43.3% of confirmed cases had rheumatology input. TABs requested by rheumatologists were twice more likely to be positive compared to requests by non-rheumatologists (30.5% vs. 14.1%).The majority of patients were started on a Prednisolone dose between 40-60mg. Rheumatologists maintained patients on high doses for at least 1 month in 54% of cases as opposed to 20% under non-rheumatologists. Monitoring was more regular for cases followed up by rheumatologists (40% vs. 21%). CONCLUSIONS: Malta has a low incidence of biopsy proven GCA. Although rheumatologists are more likely to adhere to the recommended guidelines, improvement is needed. Rheumatologists should take the lead to minimise variation and optimise management of GCA.

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Purpose The purpose of this paper is to assess the patient’s perspective on a dedicated clinic set up for patients diagnosed with an inflammatory arthritis who are being treated with a biologic. It proposes that dedicated clinics offer better overall care. The aim of this quality improvement survey is to evaluate the level of patient satisfaction with this clinic and identify any unmet needs. Design/methodology/approach This study was based on a quality improvement survey, which was developed using Zineldin’s five qualities model and assessed various aspects pertaining to service quality and improvement. A structured interview approach was used and 44 consecutive patients were recruited. Findings This paper explores key aspects that influence patient satisfaction within a rheumatology outpatient setting such as education on arthritis and biologics and involvement in decision making. It provides insight on what patients value most and it also addresses organizational aspects that can have an impact on patient satisfaction. It suggests that service quality can be linked to the degree of patient satisfaction. Research limitations/implications Direct interviewing of patients could have introduced a source of bias whilst questions are being answered. On the other hand, it provided an opportunity to clarify instantly any doubts and therefore avoiding any inadvertent errors. Practical implications This paper reinforces that specialized clinics enable the caring rheumatologist to provide better care for patients on biologics. Service providers should continue developing their services around the patient’s needs and perspectives in order to continue improving the service. Social implications Dedicated biologic clinics allow more judicious monitoring of patients who are taking these highly efficacious but costly medications. Originality/value This survey has reinforced that patients highly value dedicated clinics. These results strengthen the case that healthcare services should continue investing on specialized clinics.

BackgroundBiologic disease modifying anti-rheumatic drugs (DMARDs) have been a major breakthrough in the treatment of inflammatory arthritis. In clinical practice, providing timely monitoring to ensure continued efficacy and safety remains a challenge. The availability of a dedicated clinic for patients on biologics may help meet these standards.ObjectivesThe aim of this study was to get the patients' perspective of our dedicated biologic clinic and identify any unmet needs.MethodsPatients attending the biologic clinic between April and September 2016 and who were on a biologic for more than 2 years were interviewed by a trainee following their clinic visit. The patients were asked about their level of satisfaction on various aspects including waiting times, education, involvement in decision-making and duration of consultations.Results44 patients (23 females, 21 males) participated in the survey, of whom 21 suffered from rheumatoid arthritis, 17 from ankylosing spondylitis and 6 from psoriatic arthritis. The mean age of participants was 55.1 (SD 12.62) years. The mean DAS28 was 2.26 (SD 1.03) and the mean BASDAI was 4.21 (SD 2.4). Disease duration was less than 5 years in 20%, 6 to 10 years in 30% and more than 10 years in 50%. Overall satisfaction with arthritis education before initiation of treatment was 91%, which then dropped to 76% after treatment initiation. Satisfaction with education regarding biologic therapy was more consistent at 84% and 81% before and after starting treatment, respectively. 84% of patients reported to be satisfied with their involvement in the decision to start and continue biologic therapy. 77% of patients were satisfied with a consultation lasting 15 to 20 minutes and 77% were also satisfied with 6-monthly visits. The most valued source of education was communication with the caring rheumatologist (n=32), followed by specialist nurse education (n=15), Internet resources (n=14) and use of leaflets (n=13). 95% of patients reported to have rarely or never missed an appointment. The rheumatology advice line was used by 54% of patients, whilst the rest reported that they did not need it since starting the biologic. The greater majority of advice line users were very satisfied with the service provided. Amongst the unmet needs mentioned, were better arthritis education and the introduction of telephone consultations.ConclusionsEven though most patients were clinically well-controlled, continued education delivered by the caring rheumatologist and specialist nurse is still greatly valued. Patients attending this clinic highly valued the staff dedication and had good communication with their caring clinician. They were highly satisfied with the length and frequency of consultations. Nonetheless, a significant number suggested the need to introduce telephone consultations, which could be considered for those stable patients after receiving proper education.Disclosure of InterestNone declared

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