Giant Cell Arteritis Diagnosis and Management

Diagnostic Approach

• The American Academy of Ophthalmology recommends checking ESR and CRP immediately in an elderly female presenting with scalp tenderness and full head headache, as this represents a medical emergency requiring urgent high-dose corticosteroid therapy to prevent irreversible vision loss 1, 2, 3
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) should be obtained stat in patients with suspected giant cell arteritis (GCA) 1, 2, 3
• Jaw claudication (pain with chewing) is highly specific for GCA and should be assessed in patients with suspected GCA 1, 2, 4
• Temporal artery tenderness or decreased pulse should be evaluated in patients with suspected GCA 1, 2

Treatment and Management

• The American College of Rheumatology recommends starting high-dose corticosteroids immediately in patients with elevated ESR/CRP or high clinical suspicion of GCA, without waiting for biopsy results 3
• Urgent temporal artery biopsy should be arranged in patients with suspected GCA, which can be performed up to 2 weeks after starting steroids without affecting diagnostic yield 1, 2
• Consultation with neuro-ophthalmology or rheumatology is recommended to facilitate biopsy and coordinate care in patients with suspected GCA 1, 2

Imaging and Further Evaluation

• MRI brain with and without contrast should be obtained if there is no improvement with initial management, or if there are any focal neurological signs, progressive worsening of headache, headache awakening patient from sleep, or headache worsened by Valsalva maneuver 1, 2, 3