GCA large-vessel disease — SCE Rheumatology MCQ

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ModerateVasculitisGCA large-vessel diseaseSCE Rheumatology

A 69-year-old woman with treated giant cell arteritis has persistent constitutional symptoms and arm claudication despite improvement in headache. Temporal artery tenderness has resolved. CRP is mildly raised. There is a blood pressure difference between arms. What is the most important complication to screen for?

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Correct answer: A — Large-vessel aortitis and aneurysm risk

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

Large-vessel aortitis and aneurysm risk is best because GCA can involve the aorta and its branches, causing limb claudication and later aneurysm risk. A is less suitable because Achilles xanthoma relates to familial hypercholesterolaemia; B is less suitable because renal tubular acidosis is linked to Sjögren disease; C is less suitable because MALT lymphoma is a Sjögren complication; E is less suitable because urate stones are a gout complication. Clinical pearl: large-vessel GCA may persist despite improvement in cranial symptoms.

Reference: BSR GCA guideline 2020; EULAR imaging recommendations for large-vessel vasculitis