Giant Cell Arteritis — RACP Adult Medicine MCQ

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ModerateRheumatologyGiant Cell ArteritisRACP Adult Medicine

A 75-year-old woman presents with acute painless visual loss in her right eye. She has a history of temporal headaches, jaw claudication, and raised ESR (95 mm/hr) and CRP (120 mg/L). What is the most important immediate treatment?

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Correct answer: E — IV methylprednisolone 1 g daily for 3 days

Giant cell arteritis (GCA) with acute visual loss is an ophthalmological emergency. IV methylprednisolone (500 mg–1 g daily for 3 days) should be commenced immediately to prevent progression to bilateral visual loss, which can occur within days. Temporal artery biopsy should be arranged but must NOT delay treatment – biopsy remains positive for up to 2 weeks after starting steroids. After IV loading, switch to oral prednisolone 1 mg/kg with slow taper. Tocilizumab is a steroid-sparing agent for relapsing/refractory GCA.

Reference: eTG – 2025 – Rheumatology; BSR – 2020 – GCA Guidelines