Current clinical practice trends in giant cell arteritis diagnosis and management: a national survey of Australian rheumatologists and rheumatology trainees

INTRODUCTION: Giant cell arteritis (GCA) is the most common vasculitis of the elderly. Delayed diagnosis or inadequate treatment can lead to severe and irreversible consequences. There are limited data on diagnosis and management practices of rheumatologists and rheumatology trainees in Australia. This study aimed to determine practices and views of Australian rheumatologists/rheumatology trainees in the diagnosis and management of GCA. METHODS: An online survey was completed by Australian rheumatologists/trainees. The survey gathered data on the respondent demographics and a range of topics related to the diagnosis and management of GCA, including the use of temporal artery biopsy (TAB) and imaging, confidence in ultrasound, use of steroid-sparing medication, and approaches to aortic aneurysm screening and referral back to primary care. RESULTS: There were 58 respondents (52 rheumatologists, six trainees). On average, respondents used TAB alone (56% of respondents), imaging alone (19%), both (15%) or neither (10%). The majority of respondents (79%) rarely or never made a diagnosis of GCA without TAB. Only 40% expressed confidence in GCA diagnosis by temporal artery ultrasound from their preferred radiology provider. Management approaches following the end of government-funded tocilizumab varied. Only 12% of respondents reported that >50% of their GCA patients were able to cease prednisolone by 12 months. CONCLUSIONS: Australian rheumatologists and trainees have low confidence in ultrasound and rarely make a diagnosis of GCA without a TAB. Variable practice would support the need to develop Australian clinical care standards for GCA.