Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Start high‑dose steroids immediately when GCA suspected; arrange biopsy within 1–2 weeks.
- Screen for large‑vessel disease; add aspirin if low bleed risk.
- Plan taper and consider tocilizumab in recurrent disease; bone/ulcer prophylaxis.
Clinical Synopsis & Reasoning
In patients ≥50 with headache, scalp tenderness, jaw claudication, or visual symptoms, start high‑dose glucocorticoids immediately to prevent vision loss, then confirm with temporal artery biopsy (within 1–2 weeks) or vascular imaging. Consider steroid‑sparing tocilizumab in relapsing disease.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/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 and platelets | Inflammation | Support diagnosis | Trend response |
| Temporal artery biopsy within 1–2 weeks | Confirmation | Granulomatous inflammation | Start steroids first |
| Vascular imaging (US/MRA/CTA/PET‑CT) | Extent | Large‑vessel involvement | Aortic screening |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Visual symptoms (amaurosis fugax, diplopia) | Vision loss risk | Immediate high-dose steroids; ophtho |
| Jaw claudication or scalp necrosis | Ischemia | Expedite diagnosis/treatment |
| Aortic involvement (dissection/aneurysm) | Life-threatening | Imaging; vascular input |
| Diabetes/osteoporosis | Steroid complications | Prophylaxis; monitor |
| Relapsing disease | Refractory | Consider tocilizumab |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Prednisone 40–60 mg daily (or IV methylprednisolone 500–1000 mg ×3 days for visual symptoms) | Glucocorticoid | Hours‑days | Prevent vision loss | Taper slowly |
| Aspirin 81 mg daily (selected) | Antiplatelet | Days | Reduce ischemic complications | Bleed risk |
| Tocilizumab weekly/biweekly (refractory/relapsing) | IL‑6 blockade | Weeks | Steroid‑sparing | Infection monitoring |
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
- ACR/Vasculitis guidelines for GCA — Link