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Giant Cell Arteritis — UKMLA MCQ

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ModerateRheumatologyGiant Cell ArteritisUKMLAMRCGP AKTPARAMRCP Part 1

A 73-year-old woman presents to her GP with a new temporal headache, jaw claudication and intermittent monocular visual blurring. The visual blurring has resolved and visual acuity is currently at her baseline. ESR and CRP are markedly elevated. What is the most appropriate immediate management?

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Correct answer: A — Start prednisolone 60 mg daily immediately and arrange same-day ophthalmology assessment

This presentation strongly suggests giant cell arteritis with cranial ischaemic features: jaw claudication and a new visual symptom. Prednisolone 60 mg daily should be started immediately, before ultrasound or biopsy, because delaying treatment risks irreversible visual loss. Any new visual symptom requires same-day ophthalmology assessment; ophthalmology may escalate to intravenous methylprednisolone if ocular ischaemia or evolving visual loss is identified. Prednisolone 15 mg is a polymyalgia rheumatica dose and is inadequate for GCA. Aspirin is not a substitute for corticosteroids. Diagnostic testing must not delay treatment, and routine referral is inappropriate given the visual symptoms.

Reference: NHS Dumfries and Galloway, Joint rheumatology/ophthalmology giant cell arteritis referral guidelines, Referral process, last reviewed 20 April 2026. https://www.rightdecisions.scot.nhs.uk/dgrefhelp-nhs-dumfries-galloway/rheumatology/joint-rheumatologyophthalmology-giant-cell-arteritis-gca-referral-guidelines/