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Giant cell arteritis with visual symptoms — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologyGiant cell arteritis with visual symptomsABIM Board

A 74-year-old has new temporal headache, jaw claudication and sudden blurred vision. ESR and CRP are markedly elevated, and examination suggests arteritic anterior ischemic optic neuropathy. Temporal-artery imaging is unavailable today. What should be done now?

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Correct answer: E — Begin immediate high-dose glucocorticoid treatment and arrange early confirmatory testing

The best answer is “Begin immediate high-dose glucocorticoid treatment and arrange early confirmatory testing”. Threatened vision makes this a treatment emergency. High-dose glucocorticoids are begun immediately to protect the other eye, while biopsy or vascular imaging is arranged promptly; treatment does not make early biopsy useless. Steroid-sparing therapy may be added later but does not replace urgent glucocorticoids.

Reference: 2021 ACR/Vasculitis Foundation Guideline for Giant Cell Arteritis: https://rheumatology.org/giant-cell-arteritis-guideline