Diagnostic and management trends of giant cell arteritis: a physician survey

Abstract

Objective: Opinions regarding diagnostic and treatment issues in giant cell arteritis (GCA) vary widely, yet few controlled trials exist to address these issues. Our objective was to compare espoused clinical policies regarding diagnosis and treatment of GCA among physicians involved in GCA care.

Methods: Utilizing professional society directories, US physicians were randomly selected to receive an 11-question survey. One hundred surveys were mailed to each of the following: family medicine, general internal medicine, general/vascular surgery, neurology, ophthalmology, otolaryngology, and rheumatology. Data were analyzed according to specialty and specialty group: rheumatology, medical specialties (family medicine, general internal medicine, neurology), and surgical specialties (general/vascular, ophthalmology, and otolaryngology).

Results: The percentage of surveys returned was 34.7%. Analysis was limited to the 79% participating in at least one aspect of GCA care. Greater than 90% of respondents believe that temporal arteritis biopsy (TA Bx) should be performed in all suspected cases of GCA. Eighty-five percent of rheumatology believe TA Bx is indicated even when pretest probability of GCA is high, compared to 65% of medical specialties (p = 0.03). Eighty percent of rheumatology believe steroid usage decreases the yield of TA Bx, compared to 62% of surgical specialties (p = 0.04). When initial TA Bx is negative, medical specialties (26%) and surgical specialties (31%) were more likely than rheumatology (5%) to decline contralateral biopsy, even if the contralateral side is symptomatic (p = 0.04 and 0.01, respectively).

Conclusion: Considerable variation exists regarding key elements of diagnosis and treatment in the evaluation of suspected GCA. The morbidity of GCA and the potential toxicity of therapy highlights the need for controlled trials to address these issues.