Management of giant cell arteritis among general practitioners from Genoa, Italy: a web-based survey

Abstract

Giant cell arteritis (GCA) is the most common form of vasculitis of the adult. General practitioners (GPs) are usually the first physicians who take care of GCA patients. In this study, the awareness of GPs from Genoa, Italy, regarding GCA was investigated by a web-based survey. A web-based questionnaire was sent by mail to 775 Italian GPs. It included 12 multiple choice questions regarding practice seniority, practice population size, number of GCA patients followed, and GPs’ diagnostic and therapeutic approach. Of the 775 GPs involved, 76 (9.8%) answered. Thirty-three/75 (44%) declared that they did not see patients with GCA and the remaining 42 (56%) that they diagnose between one and two patients per year. New headache onset was the presenting feature of GCA for the majority of GPs (78.3%). GCA was diagnosed on the basis of clinical presentation alone by 35.2% of them, of temporal artery biopsy by 49.3%, and by imaging, including ultrasound and magnetic resonance imaging, by 15.5%. The referral pattern was mainly toward rheumatologists (68.5%). Only 27.8% GPs declared they start treatment at the first clinical suspicion, with the others waiting for laboratory and imaging examinations or specialist consultation. The doses of glucocorticoids used were in keeping with current guidelines. The management of GCA by GPs from Genoa is in general correct, with the exceptions of excessive confidence in headaches for diagnosis and of the timing of GC initiation. These points suggest that a program of information and education for GPs is warranted.

The dichotomy of glucocorticosteroid treatment in immuneinflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice

“…Analogously, initial high dosages of GC treatment (40-60 mg/day prednisone equivalent) are recommended for patients with a high clinical suspicion of GCA, despite an unconfirmed diagnosis with imaging techniques, due to the imminent risk of visual loss [16,17]. Although much progress has been made in introducing steroid-sparing agents such as tocilizumab (TCZ) [18], recent evidence from the GCA treatment with ultra-short GC and TCZ trial (GUSTO) suggests that GC treatment is still essential and cannot be stopped very early during the disease course due to the high frequency of relapses within the first month, detected in 75% of patients [19].…”

Do statins decrease vascular inflammation in patients at risk for large-vessel vasculitis? A retrospective observational study with FDG-PET/CT in polymyalgia rheumatica, giant cell arteritis and fever of unknown origin

“…It is commonly accompanied by systemic inflammatory signs such as fever, malaise, weight loss, and increased inflammatory indexes (4). GCA is the most frequent large-vessel vasculitis in the adult (5). It is characterised by a granulomatous inflammation of the aorta and its main branches.…”

Feasibility and usefulness of a fast-track clinic for patients suspected of polymyalgia rheumatica: notes for a work schedule through a narrative review of published literature

“…On the other hand, normal ESR and CRP should not be a reason to exclude PMR, because PMR with normal ESR and CRP concentrations at the time of diagnosis exists [ 5 , 6 ], and this applies to 14% of PMR patients, according to a recently published retrospective study [ 7 ]. Finally, PMR might present either as an isolated condition or in association (in up to 16–21% of cases) with giant cell arteritis (GCA), a large vessel vasculitis targeting the aorta and its branches [ 8 , 9 ]. Giant cell arteritis can cause irreversible sight loss if treatment with glucocorticoids (GCs) is procrastinated [ 10 ].…”