Who manages Giant Cell Arteritis (GCA)?

Who Manages Giant Cell Arteritis (GCA)

GCA requires multidisciplinary management coordinated primarily by rheumatologists in secondary/tertiary care, with essential collaboration from ophthalmologists, neurologists, vascular surgeons, and other specialists depending on the vascular territories involved. 1

Primary Care vs. Specialist Management

• GCA patients are commonly referred to secondary/tertiary care specialists rather than being managed solely in primary care, unlike polymyalgia rheumatica (PMR) which is often managed by primary care physicians 1
• Shared care between specialists and primary care physicians is desirable, with regular evaluation by an expert, particularly for difficult-to-treat cases or when GCA/PMR overlap is suspected 1
• Fast-track GCA clinics have facilitated rapid diagnosis and specialist care, helping to reduce the time from symptom onset to treatment initiation 1

Core Specialties Involved

Rheumatology (Primary Coordinating Specialty)

• Rheumatologists serve as the primary managing physicians for long-term GCA treatment, including glucocorticoid tapering and immunosuppressive therapy 1
• Rheumatologists are more likely to use advanced imaging modalities and prescribe glucocorticoid-sparing treatments compared to other specialties 2
• The 2024 EULAR guidelines specifically identify rheumatologists as key providers for implementing treat-to-target strategies in GCA 1

Ophthalmology

• Ophthalmologists are critical for managing visual complications, as sight loss occurs in 15-35% of GCA patients and has dramatic impact on quality of life 1
• Ophthalmology is the initial consulting specialty in 46% of GCA cases, particularly when patients present with visual disturbances 2
• Neuro-ophthalmologists specifically are included in multidisciplinary task forces for GCA management 1

Other Essential Specialists

• Neurologists manage stroke and other neurological complications from GCA affecting cerebral vessels 1
• Vascular surgeons address peripheral limb ischemia and other vascular complications 1
• Plastic surgeons may be needed for scalp or tongue necrosis resulting from tissue ischemia 1
• Internists and geriatricians are identified as appropriate managing physicians, particularly given the elderly patient population 1
• Specialists in vascular medicine and radiology play roles in diagnosis and monitoring of large vessel involvement 1

Why Multidisciplinary Management is Essential

• GCA presents with heterogeneous symptoms across different vascular territories, requiring expertise from multiple specialties 1, 2
• The disease can cause damage in multiple vascular territories simultaneously, including cranial vessels (causing vision loss), cerebral vessels (causing strokes), and peripheral vessels (causing limb ischemia) 1
• GCA is a medical emergency requiring immediate treatment to prevent irreversible complications, particularly vision loss, necessitating rapid coordination between specialties 1
• If one eye is affected, the risk of losing the second eye is as high as 50% without prompt multidisciplinary intervention 1

Healthcare Team Members Beyond Physicians

• Healthcare professionals in rheumatology (such as nurse practitioners and physician assistants) are specifically identified as part of the management team 1
• Pharmacists play a role in medication management and monitoring for drug interactions 1
• Patient organizations are recognized as important stakeholders in GCA care 1

Common Pitfall to Avoid

Do not delay specialist referral while attempting primary care management alone when GCA is suspected, as the imminent risk of sight loss and other ischemic events requires immediate specialist evaluation and treatment 1. The establishment of multidisciplinary or fast-track clinics has been shown to optimize GCA management and reduce time to treatment 2.