The real-world clinical decisions of physicians in the management of Takayasu arteritis and giant cell arteritis in Japan: A cross-sectional web-questionnaire survey

Yoshiyuki Abe; Takao Fujii; Yoshia Miyawaki; Takahiko Sugihara; Haruhito A Uchida; Yasuhiro Maejima; Yoshiko Watanabe; Takuya Hashimoto; Takako Miyamae; Yoshikazu Nakaoka; Masayoshi Harigai; Naoto Tamura

doi:10.1093/mr/roae034

The real-world clinical decisions of physicians in the management of Takayasu arteritis and giant cell arteritis in Japan: A cross-sectional web-questionnaire survey

Mod Rheumatol. 2024 Apr 8:roae034. doi: 10.1093/mr/roae034. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan.
² Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan.
³ Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
⁴ Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
⁵ Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
⁶ Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
⁷ Department of General Medicine, Kawasaki Medical School, Kurashiki, Japan.
⁸ Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
⁹ Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.
¹¹ Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.

PMID: 38590042
DOI: 10.1093/mr/roae034

Abstract

Objectives: To access the real-world clinical management of physicians who treat Takayasu arteritis (TAK) and giant cell arteritis (GCA) after the publication of the Japanese Circulation Society (JCS) 2017 Guidelines for the Management of Vasculitis Syndrome.

Methods: This descriptive, cross-sectional study utilized self-administered electronic questionnaires, which were answered in February 2022 by physicians treating TAK or GCA and registered with Macromill Inc.

Results: The 329 survey respondents comprised 110 cardiologists, 110 rheumatologists, 34 cardiovascular surgeons, 24 surgeons, 35 internal medicine physicians, 13 nephrologists, and 7 pediatricians. The 2017 JCS Guidelines were the most commonly referenced information source for resolving clinical questions, accessed by 70% of respondents. Ophthalmoscopy was performed in only 50% of patients with TAK, and in 70% for GCA. The median percentages of patients who underwent 18F-fluorodeoxyglucose-positron emission tomography/computed tomography for TAK and GCA patients were 23% and 20% at diagnosis, respectively, and 10% each at follow-up within 12 months. Tocilizumab was the most frequently used medication in combination with glucocorticoids for both TAK and GCA, especially in remission induction therapy for relapsed patients.

Conclusions: The majority of physician treating TAK and GCA referred to the 2017 JCS guidelines. This report clarified the current clinical practice for large vessel vasculitis in Japan, providing information for the next revision of the guidelines.

Keywords: Clinical practice guideline; Takayasu arteritis; giant cell arteritis; large vessel vasculitis; real-world clinical decision.

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