Fast-Track Clinics and Visual Outcomes in Giant Cell Arteritis: A Systematic Review and Meta-Analysis.

INTRODUCTION

Giant cell arteritis (GCA) is a chronic inflammatory disease that primarily affects medium and large arteries, predominantly in individuals over 50 years of age. Delayed diagnosis and treatment can result in severe complications, including irreversible vision loss. Conventional diagnostic pathways, often involving temporal artery biopsy, can lead to significant delays. Fast-track clinics (FTC) have been developed to expedite diagnosis and treatment, potentially improving patient outcomes. This meta-analysis aimed to compare the effectiveness of FTC and conventional practice (CP) in managing GCA.

MATERIALS AND

METHODS

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Relevant studies that compared FTC and CP in GCA management were retrieved from the MEDLINE, Cochrane, and Embase databases. Inclusion criteria required studies to report at least one of the following outcomes: visual disturbances, permanent sight loss, biopsy rates, or median days to diagnosis. The QUADAS-2 tool was used to assess the study quality and bias risk. Statistical analyses included pooled odds ratios (OR) with 95% confidence intervals (CI), heterogeneity assessment using the I2 statistic, and a random-effects model to account for study variability. Funnel plots were used to assess the publication bias.

RESULTS

Three studies included 348 patients (173 in the FTC group and 175 in the CP group). FTC implementation was linked to decreased permanent sight loss (8.09% vs. 24.57%, OR: 0.31; p <0.001) and visual disturbances (20.23% vs. 32.57%, OR: 0.58; p =0.04), and use of temporal artery biopsy was lower in the FTC group (47.40% vs. 65.14%, OR: 0.19; p =0.49). The median number of days to diagnosis was slightly lower in the FTC group (57.6 vs. 58.3 d), although the difference was not statistically significant (OR: 0.96; p =0.83).

CONCLUSION

Fast-track clinics may improve visual outcomes in patients with GCA and represent a promising approach that warrants further validation in prospective studies.