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GCA with Visual Threat — RACP Adult Medicine MCQ

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EasyRheumatologyGCA with Visual ThreatRACP Adult Medicine

A 70-year-old woman presents with new-onset headache, jaw claudication, and scalp tenderness over the temporal arteries. ESR is 90 mm/hr and CRP is 75 mg/L. She reports transient monocular visual loss in the left eye yesterday. Temporal artery biopsy shows granulomatous arteritis with giant cells. What is the most appropriate immediate management?

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Correct answer: D — IV methylprednisolone 1 g daily for 3 days then oral prednisolone

GCA with visual symptoms (amaurosis fugax) is an ophthalmological emergency. IV methylprednisolone pulse therapy (500 mg-1 g daily for 3 days) should be started immediately to prevent irreversible bilateral visual loss, followed by oral prednisolone 1 mg/kg. Temporal artery biopsy should be performed within 2 weeks (remains diagnostic for several days after steroid initiation). Tocilizumab (GiACTA trial) is now used as a steroid-sparing agent.

Reference: eTG Rheumatology – 2024 – GCA; BSR 2024 GCA; EULAR 2024