GCA — SCE Rheumatology MCQ

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A 72-year-old woman presents with a new temporal headache, scalp tenderness, weight loss and jaw pain that develops while chewing and resolves with rest. The left temporal artery is tender with reduced pulsation. Her ESR is 92 mm/hour and platelet count is 520 × 10^9/L. What is the most likely diagnosis?

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Correct answer: A — Giant cell arteritis

The diagnosis is giant cell arteritis. The decisive features are age over 50 years, a new temporal headache, scalp tenderness, true jaw claudication, an abnormal temporal artery and a marked inflammatory response with thrombocytosis. Polymyalgia rheumatica commonly coexists with GCA but does not by itself explain jaw claudication or an abnormal temporal artery. Granulomatosis with polyangiitis would more typically cause upper-airway, pulmonary or renal disease, while polyarteritis nodosa causes systemic medium-vessel disease without this characteristic cranial arterial syndrome. Takayasu arteritis usually begins in younger women and predominantly affects the aorta and its major branches. Suspected GCA is a medical emergency because treatment delay risks irreversible visual loss.

Reference: National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (CG150), section on giant cell arteritis. Updated 2025. https://www.nice.org.uk/guidance/cg150/chapter/recommendations