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Giant Cell Arteritis — SCE Rheumatology MCQ

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ModerateVasculitisGiant Cell ArteritisSCE Rheumatology

A 70-year-old man presents with jaw claudication scalp tenderness and sudden painless loss of vision in the right eye. Fundoscopy shows a pale swollen optic disc with a cherry red spot at the macula. ESR is 92 mm/hr. What immediate treatment is required?

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Correct answer: A — IV Methylprednisolone 1 g daily for 3 days followed by high-dose oral Prednisolone

Sudden visual loss in GCA constitutes an ophthalmological emergency due to anterior ischaemic optic neuropathy (AION). BSR 2020 GCA guidelines recommend immediate IV Methylprednisolone 500-1000 mg daily for 3 days followed by oral Prednisolone 60 mg daily to protect the contralateral eye. The fundoscopy description (pale swollen disc) is classic for arteritic AION. Treatment must not be delayed for biopsy. Biopsy remains diagnostic up to 2 weeks after starting steroids.

Reference: BSR 2020 - Guidelines for management of giant cell arteritis