Author Block: Kim Vo, Rahul A. Sharma, Lucia C. Petito, Danah H. Albreiki

Author Disclosure Block: K. Vo: None. R.A. Sharma: None. L.C. Petito: None. D.H. Albreiki: None.

Abstract Body:

Purpose: Immediate administration of glucocorticoids is essential in the treatment of suspected giant cell arteritis (GCA). The choice of medication dose and route depends on patient-specific factors, but may also reflect physician-specific ones, including subspecialty discipline. We have compared the management of suspected GCA cases in subspecialty versus primary care settings to (1) identify possible discrepancies in management and to (2) promote broader understanding of the evidence-based management of GCA. 

Study Design: Retrospective cohort study. Methods: This retrospective cohort study includes 286 consecutive patients with a suspected diagnosis of GCA, all of whom were referred for temporal artery biopsy at a tertiary care centre between 2009-2016. Data from the initial clinical visit were collected, including: physician subspecialty, patient demographics, symptoms, laboratory investigations and therapies received. Logistic regression models were used to assess whether any covariates were associated with the use of glucocorticoid therapy. 

Results: A total of 172 patients (60.1%) were prescribed glucocorticoids for suspected GCA. The majority (92.4%) of these patients were prescribed the medication orally; only 13 (7.6%) were prescribed intravenous medication. Compared to those evaluated in a subspecialty care setting, patients assessed in a primary care setting had 2.21 times the odds of receiving glucocorticoids (95% CI 1.31 - 3.73, p < 0.01); this association remained significant after adjustment of all patient-specific characteristics (OR 2.15, 95% CI 1.05 - 4.43, p = 0.04). Patients seen in subspecialty settings also received a higher dose (88.3 mg, IQR 0, 60 mg) than those seen in primary care settings (50.0 mg, IQR 0, 60 mg) and were more likely to receive medication intravenously (OR 3.05, 95% CI 0.66 - 14.0, p = 0.15).

Conclusions: Our results suggest that physicians with subspecialty expertise prescribe glucocorticoids more readily and at higher doses in cases of suspected GCA. These discrepancies indicate a potential area for improvement in achieving quality, evidence-based care for all patients with GCA.