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Giant cell arteritis — SCE Rheumatology MCQ

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HardVasculitisGiant cell arteritisSCE Rheumatology

A 63-year-old man has new temporal headache, scalp tenderness and jaw claudication. Examination shows the temporal artery is tender and pulsation is reduced. Investigations show ESR is 96 mm/hour with thrombocytosis. Conventional therapy has been optimised and a biologic or targeted agent is being considered according to UK specialist practice. Infection screening has been completed and shared-care monitoring is in place. What is the most appropriate biologic?

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Correct answer: B — Tocilizumab

Tocilizumab is the best answer because tocilizumab best matches the disease domain and escalation pathway for giant cell arteritis. Etanercept is a plausible distractor, but it does not account for the key discriminator in the stem. Adalimumab and Certolizumab pegol would be more appropriate in a different clinical pattern or at another point in the pathway, while Mepolizumab is suboptimal for this presentation. Clinical pearl: biologic choice depends on disease domain, previous biologic exposure, comorbidity, infection screening and commissioning criteria.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF