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GCA Negative Biopsy — RACP Adult Medicine MCQ

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EasyRheumatologyGCA Negative BiopsyRACP Adult Medicine

A 78-year-old man presents with a 3-month history of temporal headaches, scalp tenderness, and jaw claudication. His ESR is 110 mm/hr and CRP is 95 mg/L. Temporal artery biopsy is performed but shows no giant cells. What is the correct interpretation?

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Correct answer: A — Skip lesions mean a negative biopsy does NOT exclude GCA – continue treatment

Temporal artery biopsy in GCA can be negative in up to 15–40% of cases due to skip lesions (non-contiguous segmental involvement). A negative biopsy does NOT exclude GCA. If clinical suspicion is high (as in this case with classic symptoms and markedly elevated inflammatory markers), treatment with high-dose corticosteroids should be continued. Longer biopsy specimens (>2 cm) and bilateral biopsies increase sensitivity. Ultrasound showing the 'halo sign' can support the diagnosis non-invasively.

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