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Giant cell arteritis — SCE Rheumatology MCQ

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ModerateVasculitisGiant cell arteritisSCE Rheumatology

A 29-year-old woman 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. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — Tocilizumab with glucocorticoid taper

Tocilizumab with glucocorticoid taper is the best answer because tocilizumab with glucocorticoid taper is the most appropriate next step for giant cell arteritis in this clinical setting. Mycophenolate mofetil is a plausible distractor, but it does not account for the key discriminator in the stem. Bisphosphonate therapy and Urgent antibiotics would be more appropriate in a different clinical pattern or at another point in the pathway, while Cyclophosphamide induction is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

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