TAB After Steroid Start — SCE Rheumatology MCQ
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Correct answer: B — Proceed now; biopsy can remain diagnostic after glucocorticoids and should ideally occur within 2 weeks of starting them.
Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E
A is correct. Glucocorticoid treatment for suspected GCA must not be delayed while awaiting diagnostic testing because ischaemic visual loss may be irreversible. Temporal artery inflammation does not disappear immediately after treatment; a biopsy performed after 5 days can still be diagnostic. It should nevertheless be obtained promptly, ideally within 2 weeks, because diagnostic yield may decline with increasing glucocorticoid exposure. A negative biopsy does not by itself exclude GCA because arterial involvement may be segmental and biopsy sensitivity is imperfect. Options B, D and E incorrectly assume that treatment rapidly invalidates biopsy or that delay improves histology. Option C is unsafe: glucocorticoids should not be interrupted to increase biopsy yield.
Reference: The BMJ. Giant cell arteritis. Diagnostic testing and treatment section. 2026. https://pubmed.ncbi.nlm.nih.gov/11973248/