guidelines

giant cell arteritis (temporal arteritis)

nice cks: immediate high-dose steroids (do not wait), visual symptom escalation, and urgent referral for confirmation/monitoring.

last reviewed: 2026-02-13
based on: NICE CKS: Giant cell arteritis (accessed Feb 2026)

Executive summary (time-critical)

  • Do not delay treatment: start high-dose steroids immediately if GCA is suspected — do not wait for tests or specialist review.
  • Vision is the stake: visual symptoms require emergency escalation (same day) and specialist-directed management.
  • Confirm and taper safely: urgent referral for diagnostic confirmation (imaging/biopsy per pathway) and structured taper/monitoring.

Red flag symptoms (treat + refer urgently)

  • New temporal headache, scalp tenderness, jaw claudication, visual disturbance (blurred vision, diplopia, transient loss of vision), systemic symptoms (fever, weight loss).
  • Association with PMR symptoms is common.

Immediate management (primary care actions)

  • Start steroids now: typical CKS-style dosing is prednisolone 40–60 mg OD (dose individualise; specialist pathways may differ for visual symptoms).
  • Same-day referral if visual symptoms, neurological features, or very high suspicion.
  • Baseline tests: ESR/CRP, FBC, U&Es, LFTs, glucose; but do not wait to start steroids.
  • Safety: consider gastric and bone protection strategies and steroid monitoring plan.

Transparency

This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.