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Giant cell arteritis with transient visual symptoms — SCE Acute Medicine MCQ

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EasyAcute Rheumatological EmergenciesGiant cell arteritis with transient visual symptomsSCE Acute Medicine

A 73-year-old woman presents with new headache, jaw claudication and transient monocular visual loss. ESR is 92 mm/hour and CRP is 116 mg/L. Temporal artery is tender and visual acuity is currently normal. What is the most appropriate next step in management?

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Correct answer: B — Start immediate high-dose corticosteroid treatment and arrange urgent specialist assessment

The combination of new headache, jaw claudication, high inflammatory markers and visual symptoms is giant cell arteritis until proven otherwise, requiring immediate steroids to prevent visual loss. Biopsy or ultrasound should be arranged but must not delay treatment. Anticoagulation does not address the vasculitic mechanism. The teaching point is that transient visual symptoms are an emergency in suspected GCA.

Reference: BSR giant cell arteritis guideline, NICE CKS GCA, BNF