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Giant cell arteritis with evolving visual loss — SCE Acute Medicine MCQ

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HardMusculoskeletal systemGiant cell arteritis with evolving visual lossSCE Acute Medicine

A 65-year-old woman with polymyalgia rheumatica presents with sudden bilateral visual blurring and headache. ESR is 104 mm/hour. She received oral prednisolone 40 mg in the morning from her GP. In the acute medical unit, she develops complete loss of vision in one eye. What is the most appropriate next step in management?

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Correct answer: D — Escalate to intravenous methylprednisolone and urgent ophthalmology/rheumatology review

Visual loss in suspected giant cell arteritis is an emergency requiring immediate high-dose steroid escalation and urgent specialist review. Treatment must not be delayed for biopsy or ultrasound. Oral dosing may be appropriate for uncomplicated disease, but evolving visual loss warrants more aggressive therapy according to local pathways.

Reference: BSR Giant Cell Arteritis Guideline