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GCA Treatment Urgency — RACP Adult Medicine MCQ

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EasyRheumatologyGCA Treatment UrgencyRACP Adult Medicine

A 70-year-old man with suspected giant cell arteritis has a temporal artery biopsy scheduled for 5 days' time. He has jaw claudication but no visual symptoms. Should corticosteroids be commenced immediately or deferred until biopsy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Start low-dose prednisolone (10 mg) and increase after biopsy

Corticosteroids should NEVER be withheld pending biopsy in suspected GCA. Delayed treatment risks irreversible visual loss. Prednisolone 40–60 mg daily (or IV methylprednisolone if visual symptoms are present) should be commenced IMMEDIATELY upon clinical suspicion. Temporal artery biopsy remains positive for up to 2–4 weeks after commencing corticosteroids, so there is no justification for delaying treatment. Biopsy should still be performed within 2 weeks of starting steroids.

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