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Giant cell arteritis with visual symptoms — SCE Acute Medicine MCQ

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EasyAcute Rheumatological EmergenciesGiant cell arteritis with visual symptomsSCE Acute Medicine

A 74-year-old woman presents with new temporal headache, jaw claudication and transient loss of vision in the right eye. ESR is 88 mm/hour and CRP is 112 mg/L. Examination shows a tender, reduced-pulse temporal artery. What is the most important immediate action?

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Correct answer: E — Start high-dose glucocorticoids urgently and arrange specialist assessment

Visual symptoms with cranial features of GCA are an emergency, and glucocorticoids should start immediately to prevent permanent sight loss. Biopsy or ultrasound should be arranged but must not delay treatment. Analgesia alone ignores the risk of ischaemic optic neuropathy. The pearl is that jaw claudication is highly suggestive of cranial GCA.

Reference: BSR Giant Cell Arteritis guideline