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Giant cell arteritis — SCE Rheumatology MCQ

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EasyVasculitisGiant cell arteritisSCE Rheumatology

A 79-year-old man presents with suspected giant cell arteritis and amaurosis fugax. He has jaw claudication, scalp tenderness and CRP 146 mg/L. Ophthalmology review is being arranged and temporal artery ultrasound is available tomorrow morning. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Start high-dose glucocorticoids immediately

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

Start high-dose glucocorticoids immediately is best because suspected GCA with visual symptoms requires immediate high-dose glucocorticoids to protect sight. A is less suitable because antibiotics do not treat cranial vasculitis; B is less suitable because methotrexate monotherapy is inadequate acutely; C is less suitable because biopsy or ultrasound should not delay treatment; D is less suitable because aspirin alone does not control arteritic inflammation. Clinical pearl: diagnostic confirmation is important, but treatment comes first when vision is threatened.

Reference: BSR GCA guideline 2020; NICE CKS GCA