Clini P, Stimamiglio A, Camellino D, Hysa E, Cutolo M, Cimmino M A
Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova.
General Practice, Azienda Sanitaria Locale 3 "Genovese", Genova.
Reumatismo. 2021 Jan 18;72(4):207-212. doi: 10.4081/reumatismo.2020.1291.
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.
巨细胞动脉炎（GCA）是成人最常见的血管炎形式。全科医生（GPs）通常是首批诊治GCA患者的医生。在本研究中，通过一项基于网络的调查，对意大利热那亚的全科医生对GCA的认知情况进行了调查。通过邮件向775名意大利全科医生发送了一份基于网络的问卷。问卷包括12个多项选择题，涉及执业资历、执业人群规模、随访的GCA患者数量以及全科医生的诊断和治疗方法。在参与调查的775名全科医生中，76名（9.8%）进行了回复。75名中有33名（44%）宣称他们没有诊治过GCA患者，其余42名（56%）称他们每年诊断1至2名患者。对于大多数全科医生（78.3%）而言，新发头痛是GCA的主要表现特征。其中35.2%的全科医生仅根据临床表现诊断GCA，49.3%通过颞动脉活检诊断，15.5%通过包括超声和磁共振成像在内的影像学检查诊断。转诊模式主要是转诊至风湿病专科医生（68.5%）。只有27.8%的全科医生宣称他们在首次临床怀疑时就开始治疗，其他医生则等待实验室和影像学检查结果或专科会诊。所使用的糖皮质激素剂量符合当前指南。热那亚的全科医生对GCA的管理总体正确，但在诊断时对头痛过度依赖以及糖皮质激素起始治疗时机方面存在不足。这些情况表明有必要为全科医生开展信息和教育项目。
