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Large-vessel vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisLarge-vessel vasculitisSCE Rheumatology

A 68-year-old woman with established giant cell arteritis, currently receiving glucocorticoid therapy, develops exertional left arm pain. The left brachial blood pressure is 28 mmHg lower than the right, and bruits are audible over both subclavian arteries. Her CRP has risen. Which investigation is most appropriate to delineate the extent of extracranial arterial stenosis and identify other structural complications of large-vessel GCA?

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Correct answer: A — CT or MR angiography of the aorta and its major branches

The correct answer is **D: CT or MR angiography of the aorta and its major branches**. Arm claudication, a marked inter-arm blood-pressure difference and subclavian bruits indicate extracranial large-vessel involvement, while the rising CRP raises concern about active or recurrent GCA. Angiographic cross-sectional imaging delineates stenosis or occlusion and screens the aorta and other branches for dilatation or aneurysm. Temporal artery biopsy or temporal ultrasonography would not define the extent of established extracranial disease. Echocardiography cannot adequately assess the subclavian arteries or most of the aorta. Conventional catheter angiography is invasive and is generally reserved for planned vascular intervention rather than initial mapping because CTA and MRA provide appropriate non-invasive assessment.

Reference: Dejaco C, Ramiro S, Bond M, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Annals of the Rheumatic Diseases. 2024;83:741–751. Recommendation 8. https://pubmed.ncbi.nlm.nih.gov/37550004/