Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or immunomodulation when indicated; document follow‑up and patient education.
Algorithm
- Start high‑dose steroids immediately when GCA suspected (do not await biopsy).
- Order ESR/CRP; arrange temporal artery biopsy within 1–2 weeks (longer window if already on steroids).
- Screen for large‑vessel involvement with imaging as indicated.
- Add tocilizumab for relapsing/refractory disease; plan steroid taper and bone protection.
- Monitor for complications (aortic aneurysm) and relapse; coordinate ophthalmology if visual symptoms.
Clinical Synopsis & Reasoning
Age ≥50 with new headache, scalp tenderness, jaw claudication, or vision symptoms. Start high‑dose glucocorticoids immediately to protect vision; obtain temporal artery biopsy within 1–2 weeks and consider vascular imaging; add tocilizumab in selected patients.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced or procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| ESR/CRP | Inflammation | Elevated | Support diagnosis |
| Temporal artery biopsy/ultrasound | Confirmation | Granulomatous vasculitis, halo sign | Do not delay steroids for biopsy |
| Vascular imaging (CTA/MRA/PET) | Large‑vessel involvement | Aortic branch disease | Guides therapy |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Prednisone 40–60 mg PO daily (or IV methylpred 500–1000 mg x3 if vision loss) | Glucocorticoid | Hours | Vision protection and symptom control | Taper guided by symptoms and markers |
| Tocilizumab 162 mg SC weekly | IL‑6 receptor blocker | Weeks | Steroid‑sparing agent | Infection risk |
| Low‑dose aspirin (selected) | Antiplatelet | Hours | May reduce ischemic events | Bleeding risk |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- 2021 ACR/VF Guideline for Management of GCA and Takayasu Arteritis — Link