449. The first published GCA case-series in Bahrain, Diagnosis and management

Background/ Objectives: Giant cell arteritis (GCA) is the most common vasculitis in adulthood with an annual incidence of 1/5,000-1/17,000 adults over 50 years old. It is more frequent in populations of northern European background. Incidence of GCA in Arab population is not common and unknown. To date there is no single publication about GCA diagnosis and management in Bahrain. In Bahrain, the diagnosis in the past was solely dependent on the histopathological findings of unilateral temporal artery biopsy which was rarely done and never positive. In this first case series, 4 cases of GCA patients, diagnosed by using the Clinical diagnostic algorithm for GCA based on the BSR guidelines and their management will be reported. Methods: Four cases of patients with Giant Cell Arteritis were reviewed who were seen in the Rheumatology clinic in 2021. Results: this case series is the first of type to be reported in Bahrain. In this series the ratio of men to women was 1:1 with age at diagnosis ranging between 70-82 years. All four cases are Bahrainis in origin with different co-morbidities. The mean time from onset of symptoms to diagnosis was 127 days (range from 60 days to 210 days and Median of 120 days). The common symptoms they had headache 100%, Jaw claudication 100%, scalp tenderness 100%, visual symptoms 75%, and constitutional symptoms in 50% of the cases. ESR was between 25mm/hr to 110mm/hr with mean of 58.5. C-reactive protein was between 12 mg/L to 81 mg/L with mean of 44.5 mg/L. Among the four cases only case number (2) had a unilateral temporal artery biopsy while on prednisone with dose of 60 mg and it was reported as negative. Ultrasound imaging was performed on the four cases, MRI brain on two cases and PET CT scan on one case. All four case received prednisone 40-60 mg, Methotrexate 20mg/wk in three cases, and Tocilizumab IV 8mg/kg in two cases. Conclusions: These four cases demonstrate the difficulties faced in diagnosing of GCA in Arabs as it's not a common disease, the challenges faced in diagnosis and the delay in starting the treatment. Unfortunately complete vision loss was in 50% of the cases with partial loss in 25%. Disclosures: The author has declared no conflicts of interes