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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 73-year-old woman has new headache, jaw claudication, and two episodes of transient monocular blindness. ESR and CRP are elevated. Temporal-artery biopsy can be arranged in four days. What should be done now?

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Correct answer: E — Give pulse intravenous glucocorticoids and arrange diagnostic confirmation

The best answer is “Give pulse intravenous glucocorticoids and arrange diagnostic confirmation”. Transient visual loss represents threatened cranial ischemia. Immediate high-dose treatment is required, with pulse intravenous glucocorticoids favored when vision is threatened; diagnostic testing follows and should not delay therapy. Biopsy can remain informative after treatment begins. Tocilizumab may reduce relapse and steroid exposure but does not replace urgent glucocorticoid induction.

Reference: 2021 ACR/Vasculitis Foundation Guideline for Giant Cell Arteritis: https://pmc.ncbi.nlm.nih.gov/articles/PMC12344504/