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Large-vessel giant cell arteritis — SCE Rheumatology MCQ

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HardVasculitisLarge-vessel giant cell arteritisSCE Rheumatology

A 69-year-old man treated for polymyalgia rheumatica reports recurrent shoulder pain during steroid taper. He now has weight loss, night sweats and unequal arm blood pressures. CRP is 64 mg/L and PET-CT shows uptake in the aorta and subclavian arteries. What is the most likely diagnosis?

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Correct answer: B — Large-vessel giant cell arteritis

Systemic symptoms, refractory PMR features, unequal arm blood pressures and PET-CT large-vessel uptake support large-vessel GCA. Relapsing PMR alone would not explain vascular asymmetry. Large-vessel imaging is important when cranial symptoms are absent or disease behaves atypically.

Reference: BSR giant cell arteritis guideline; EULAR imaging in large-vessel vasculitis