Giant Cell Arteritis — SCE Rheumatology MCQ

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HardVasculitisGiant Cell ArteritisSCE Rheumatology

A 55-year-old woman with GCA on Tocilizumab and Prednisolone has her CRP monitored. CRP remains <1 mg/L throughout treatment. She develops new jaw claudication and temporal tenderness. What is the significance of the normal CRP?

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Correct answer: E — CRP is unreliable during tocilizumab treatment

Tocilizumab (IL-6 receptor inhibitor) blocks the hepatic acute phase response, suppressing CRP production regardless of disease activity. This means CRP is unreliable for monitoring GCA activity in patients on Tocilizumab. Clinical assessment (symptoms, temporal artery examination, visual assessment) becomes paramount. BSR 2020 GCA guidelines and NICE TA518 acknowledge this limitation. ESR may also be suppressed. Imaging (ultrasound, PET-CT) may have a role in monitoring disease activity on Tocilizumab.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions