Management of giant-cell arteritis in Switzerland: an online national survey.

Iudici, Michele; Hemmig, Andrea Katharina; Stegert, Mihaela; Courvoisier, Courvoisier; Adler, Sabine; Becker, Mike Oliver; Berger, Christoph T; Dan, Diana; Finckh, Axel; Mahr, Alfred; Neumann, Thomas; Reichenbach, Stephan; Ribi, Camillo; Seitz, Luca; Villiger, Peter; Wildi, Lukas; Daikeler, Thomas (2023). Management of giant-cell arteritis in Switzerland: an online national survey. Swiss medical weekly, 153(40051), p. 40051. SMW supporting association 10.57187/smw.2023.40051

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AIMS OF THE STUDY

To assess current practices in diagnosing, treating, and following-up giant-cell arteritis by specialists in Switzerland and to identify the main barriers to using diagnostic tools.

METHODS

We performed a national survey of specialists potentially caring for patients with giant-cell arteritis. The survey was sent by email to all members of the Swiss Societies of Rheumatology and for Allergy and Immunology. A reminder was sent to nonresponders after 4 and 12 weeks. Its questions covered the following dimensions: respondents' main characteristics, diagnosis, treatment, and imaging's role during follow-up. The main study results were summarized using descriptive statistics.

RESULTS

Ninety-one specialists, primarily aged 46-65 years (n = 53/89; 59%), working in academic or nonacademic hospitals or private practice, and treating a median of 7.5 (interquartile range [IQR]: 3-12) patients with giant-cell arteritis per year participated in this survey. Ultrasound of temporal arteries/large vessels (n = 75/90; 83%) and positron-emission-tomography-computed tomography (n = 52/91; 57%) or magnetic resonance imaging (n = 46/90; 51%) of the aorta/extracranial arteries were the most common techniques used to diagnose giant-cell arteritis with cranial or large vessel involvement, respectively. Most participants reported a short time to obtain imaging tests or arterial biopsy. The glucocorticoid tapering scheme, glucocorticoid-sparing agent, and glucocorticoid-sparing treatment duration varied among the participants. Most physicians did not follow a predefined repeat imaging scheme for follow-up and mainly relied on structural changes (vascular thickening, stenosis, or dilatation) to drive treatment choice.

CONCLUSIONS

This survey indicates that imaging and temporal biopsy are rapidly accessible for diagnosing giant-cell arteritis in Switzerland but highlights heterogeneous practice in many disease management areas.

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