Session Information
Date: Tuesday, October 23, 2018
Session Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Giant-cell arteritis (GCA) is the most common vasculitis. Specialists have formulated recommendations on how to manage a patient with a possible diagnosis of GCA. However, general practitioners’ (GPs) and internal medicine or rheumatology specialists’ practices may differ from those recommendations.
Methods: We conducted an opinion survey to determine how they would hypothetically diagnose and manage a suspected case of GCA in France, based on 2 very short “case-vignette” clinical case descriptions, each representing a situation more-or-less typical of GCA, followed by multiple- or single-choice questions. Questionnaires were emailed via the French doctors’ Medical Association, and French societies of internal medicine (SNFMI) and rheumatology (SFR).
Results: Between November 2016 and March 2018, 967 GPs and 485 specialists returned their completed questionnaires. Respectively, >46% and 96%, reported having had a confirmed GCA case in consultation. Hypothetical responses, expressed as the % of cases, are how these doctors think they would react to the described cases. Among GPs, 49.1% would systematically refer the patient to a specialist. GPs would initially diagnose 32.1% and prescribe glucocorticoids (GCs), for the most typical GCA case (P<0.05), without any visual complications (P<0.05). GPs with a prior suspected-GCA case would start GCs more often (P<0.05). GPs would start GCs for 40.6%, at 1 mg/kg/day for 66.4% of them, and set up a temporal artery biopsy (TAB), within a mean of 7–15 days for 78.8%, and imaging studies for 10.2%, mainly TA-color duplex ultrasonography (TA-CDU) for 77.5%. GPs would prescribe antiplatelet drugs for 17.8%. Internal medicine and rheumatology specialists would order a TAB for 80.6%, within a mean of 4–7 days, and imaging investigations for 16.2%, mainly TA-CDU (68.8%) or PET scan (43.9%). Among specialists starting GCs, the preferred dose would be 0.7 mg/kg/day for 46.9%. Specialists would prescribe antiplatelet drugs to 51.7%. Among GPs and specialists who would start GCs, TABs would be ordered for similar percentages of cases, but specialists did so earlier (P<0.05). GPs and specialists prescribed GCs based only on clinical findings for 14.1% and 8.7%, respectively. GPs would not order a TAB, considering it too complicated to set up, for 67%. Specialists used imaging more often to diagnose GCA (P<0.05). Finally, GPs would prescribe significantly higher GC doses (P<0.05).
Conclusion: Based on survey findings for 2 hypothetical cases, nearly a third of GCA cases would be managed by GPs alone. GPs and specialists would prefer TAB as the diagnostic test and TA-CDU as the imaging modality, and neither group would seek confirmation for 14.1% or 8.7%, respectively. Daily GC doses and antiplatelet-drug prescriptions would differ between GPs and specialists.
To cite this abstract in AMA style:
Guillet H, Porcher R, Saraux A, Guillevin L, Mouthon L, Régent A. Diagnostic and Therapeutic Management of a Suspected Case of GCA: An Opinion Survey [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/diagnostic-and-therapeutic-management-of-a-suspected-case-of-gca-an-opinion-survey/. Accessed June 14, 2021.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnostic-and-therapeutic-management-of-a-suspected-case-of-gca-an-opinion-survey/