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GCA Fast-Track Pathway — SCE Rheumatology MCQ

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ModerateVasculitisGCA Fast-Track PathwaySCE Rheumatology

A 65-year-old woman with suspected GCA is seen urgently in a GCA fast-track clinic. She has new temporal headache and jaw claudication. CRP is 82 mg/L. Temporal artery ultrasound shows bilateral halo sign. According to BSR 2020 what is the recommended management pathway?

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Correct answer: D — Treat immediately on positive ultrasound

BSR 2020 GCA guidelines recommend starting glucocorticoids immediately when GCA is clinically suspected without waiting for any investigation results. A positive halo sign on temporal artery ultrasound in an experienced centre has high positive predictive value (>95% specificity) and may be sufficient for diagnosis without proceeding to biopsy. Fast-track GCA pathways (same-day specialist assessment with ultrasound) have been shown to reduce sight loss rates and unnecessary steroid courses. If ultrasound is negative but clinical suspicion remains high temporal artery biopsy and/or further imaging (MRI CTA PET-CT) should be pursued.

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