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GCA Flare Management — SCE Rheumatology MCQ

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ModerateVasculitisGCA Flare ManagementSCE Rheumatology

A 60-year-old woman with GCA has been on Prednisolone for 2 years and is now on 5 mg daily. She develops new jaw claudication. Her CRP rises from 3 to 45 mg/L. What constitutes a GCA flare and what is the management?

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Correct answer: B — Clinical features of GCA recurring (headache visual symptoms jaw claudication scalp tenderness) with or without inflammatory marker rise; management involves returning to the last effective dose

A GCA flare is defined by recurrence of GCA symptoms (headache jaw claudication scalp tenderness visual symptoms temporal artery tenderness) with or without a rise in ESR/CRP. BSR 2020 GCA guidelines recommend increasing the Prednisolone dose to the last effective dose (not necessarily back to the initial dose) when a flare occurs. In this patient with jaw claudication and CRP rise returning to the previous dose that controlled symptoms (e.g. 15-20 mg) is appropriate. Recurrent flares during tapering should prompt consideration of steroid-sparing therapy (Tocilizumab per NICE TA518).

Reference: BSR 2020 GCA guidelines; NICE TA518 Tocilizumab for GCA