skip to main content

Giant cell arteritis with amaurosis fugax — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCranial IschaemiaGiant cell arteritis with amaurosis fugaxSCE Rheumatology

A 74-year-old woman presents with a 2-week history of a new right temporal headache, scalp tenderness and pain in the jaw and tongue while chewing. This morning, a dark curtain descended over her right eye for 12 minutes before vision returned completely. Visual acuity, colour vision, pupillary responses and fundoscopy are currently normal. There is no focal neurological deficit. CRP is 58 mg/L, ESR 72 mm/hour and platelet count 526 × 10^9/L. Giant cell arteritis with amaurosis fugax is strongly suspected. Intravenous treatment and same-day ophthalmological assessment are immediately available; temporal and axillary artery ultrasonography can be performed in four hours. Which initial management plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Start intravenous methylprednisolone 500–1000 mg daily for up to 3 days now, then oral prednisolone, with urgent ophthalmological assessment and ultrasonography

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

The transient monocular negative visual phenomenon is amaurosis fugax and therefore constitutes cranial ischaemia from suspected giant cell arteritis, despite complete recovery and a normal current ocular examination. Together with jaw and tongue claudication, thrombocytosis and raised inflammatory markers, it indicates a high risk of irreversible visual loss. With intravenous treatment immediately available, pulse methylprednisolone 500–1000 mg daily for up to 3 days should be commenced, followed by high-dose oral prednisolone. Ophthalmological assessment and diagnostic testing remain urgent but must not delay glucocorticoids. A is a reasonable fallback if intravenous treatment is unavailable or would be delayed, and oral prednisolone should then be given immediately; however, available intravenous therapy is preferred for acute or intermittent visual loss. C under-treats current complicated GCA: amaurosis fugax itself is the indication for escalation rather than a reason to wait for permanent loss. D is unsafe because neither ultrasonography nor biopsy should postpone treatment when clinical suspicion is strong and ischaemic manifestations are present. E may be relevant as glucocorticoid-sparing therapy in selected GCA populations, but it does not replace appropriate immediate glucocorticoid induction for threatened vision.

Reference: British Society for Rheumatology guidelines: Giant cell arteritis (2020; status checked August 2026) — https://www.rheumatology.org.uk/guidelines/artmid/1257/articleid/207/management-of-adult-patients-with-idiopathic-inflammatory-myopathy-myositis Upadacitinib for treating giant cell arteritis: committee papers (2025/2026) — https://www.nice.org.uk/guidance/GID-TA11330/documents/committee-papers British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis (2020) — https://pubmed.ncbi.nlm.nih.gov/31970405/