Giant cell arteritis biologic therapy — SCE Rheumatology MCQ

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ModerateVasculitisGiant cell arteritis biologic therapySCE Rheumatology

A 68-year-old woman with biopsy-proven giant cell arteritis has relapsed twice during glucocorticoid tapering and has steroid-induced diabetes. She has no active infection and TB screening is negative. She has not previously received an IL-6 inhibitor. What is the most appropriate biologic?

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Correct answer: C — Tocilizumab

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

Tocilizumab is best because tocilizumab is recommended in UK guidance for relapsing or refractory GCA with glucocorticoid tapering when criteria are met. A is less suitable because rituximab is used in ANCA vasculitis and RA but not typical GCA relapse treatment; B is less suitable because secukinumab treats selected spondyloarthritis/PsA rather than GCA; C is less suitable because belimumab treats SLE; D is less suitable because adalimumab is not a standard GCA biologic. Clinical pearl: IL-6 blockade suppresses CRP, so relapse monitoring must rely heavily on symptoms and imaging.

Reference: NICE TA518; BSR GCA guideline 2020