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Temporal artery biopsy — SCE Rheumatology MCQ

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HardMusculoskeletal InvestigationsTemporal artery biopsySCE Rheumatology

A 76-year-old woman started prednisolone 4 days ago for suspected GCA. Headache and jaw claudication have improved. Ultrasound is unavailable locally for 2 weeks. The clinician wants histological confirmation. What is the most appropriate investigation?

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Correct answer: B — Temporal artery biopsy arranged promptly

The best answer is “Temporal artery biopsy arranged promptly”. Temporal artery biopsy arranged promptly most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Anti-centromere antibody, within a rheumatology pathway”, “Serum urate, after safety review, after specialist review”, “Cancel investigation because steroids have started”, “Synovial fluid aspiration, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR guideline on giant cell arteritis: https://academic.oup.com/rheumatology/article/59/3/e1/5714024