Guillet H, Saraux A, Mouthon L, Régent A
Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, Paris, France.
Service de rhumatologie, Hôpital de la Cavale Blanche, CHRU, Brest, France; Université de Bretagne Occidentale, 22, rue Camille-Desmoulins, 29238 Brest, France.
Rev Med Interne. 2021 Sep;42(9):600-607. doi: 10.1016/j.revmed.2021.02.010. Epub 2021 Mar 13.
Headache, visual disturbances and shoulder and hip girdle pain are frequent symptoms of consultation and the diagnosis of giant cell arteritis (GCA) can be evoked in these situations. However, GCA is a rare disease, and the management modalities of a clinical suspicion of GCA are poorly described, which warranted this study.
This is a survey evaluating the management of a suspected case of GCA. The questionnaires were sent to general practitioners (GPs), members of the French Rheumatology Society (SFR) and the French National Society of Internal Medicine (SNFMI) RESULTS: One thousand four hundred and fifty two physicians responded to the survey, including 967 GPs (66.6 %) and 485 other specialists (33.4 %). GPs immediately referred the patient to the emergency room in 42 % of cases, and to a specialist colleague in 72 % of cases in the presence of visual symptoms. GPs and other specialists reported performing temporal artery biopsy (TAB) respectively in 46.7 % and 69.7 % of cases (P<0.05). GPs and other specialists reported using diagnostic imaging in 7.4 % and 16.2 % of cases, respectively (P<0.05). Temporal artery ultrasound was the most used diagnostic imaging. The average prednisone equivalent dose prescribed as initial treatment was 1mg/kg/day for GPs and 0.7mg/kg/day for other specialists (P<0.05).
Some suspected GCA patients would be managed by their GPs. Imaging was little used for the diagnosis of GCA and TAB remained the preferred diagnostic examination. The initial prednisone equivalent dose varied between GP and other specialists.
头痛、视力障碍以及肩带和腰带疼痛是常见的就诊症状，在这些情况下可能会引发巨细胞动脉炎（GCA）的诊断。然而，GCA是一种罕见疾病，临床怀疑GCA时的管理模式描述甚少，这使得本研究很有必要。
这是一项评估疑似GCA病例管理情况的调查。问卷被发送给全科医生（GPs）、法国风湿病学会（SFR）成员以及法国国家内科协会（SNFMI）成员。结果：1452名医生回复了调查，其中包括967名全科医生（66.6%）和485名其他专科医生（33.4%）。在42%的病例中，全科医生会立即将患者转诊至急诊室；在出现视力症状的病例中，72%的全科医生会将患者转诊给专科同事。全科医生和其他专科医生分别报告在46.7%和69.7%的病例中进行了颞动脉活检（TAB）（P<0.05）。全科医生和其他专科医生分别报告在7.4%和16.2%的病例中使用了诊断成像（P<0.05）。颞动脉超声是最常用的诊断成像。作为初始治疗开出的泼尼松等效剂量，全科医生平均为1mg/kg/天，其他专科医生平均为0.7mg/kg/天（P<0.05）。
一些疑似GCA的患者将由他们的全科医生进行管理。成像在GCA诊断中使用较少，而TAB仍然是首选的诊断检查。全科医生和其他专科医生开出的初始泼尼松等效剂量有所不同。
