Giant Cell Arteritis

GCA — large-vessel vasculitis in >50s: new headache, scalp tenderness, jaw claudication, raised ESR/CRP. Visual symptoms = impending irreversible blindness — give IV methylprednisolone immediately, before any confirmatory test. Steroids do not…

GCA Fast-Track Pathway

The pathway

1 · Recognise

Age >50 + new headache
Jaw claudication (most specific), scalp tenderness
Visual symptoms: amaurosis fugax, diplopia, blur
ESR/CRP raised (normal in ~5%)

2 · Treat immediately

Visual symptoms → IV methylprednisolone 500mg–1g OD × 3 days
No visual symptoms → prednisolone 40–60mg PO daily
Never wait for biopsy

3 · Same-day referrals

Visual symptoms → ophthalmology same day
All → rheumatology fast-track GCA pathway

4 · Confirm

Temporal artery US — halo sign
Biopsy within 2 weeks of steroids (skip lesions occur)

5 · Protect & package

Aspirin 75mg (local policy)
PPI + bone protection + glucose monitoring
Watch the fellow eye

6 · Taper slowly

Months–2 years of steroids, rheumatology-led
Tocilizumab/methotrexate for relapsing disease
PMR overlap in 40–60%

Drugs

Drug	Dose	Route	Notes
Methylprednisolone	500mg–1g OD × 3 days	IV	For any visual involvement. Then convert to high-dose oral.
Prednisolone	40–60mg OD	PO	Uncomplicated GCA without visual symptoms.
Aspirin	75mg OD	PO	May reduce ischaemic events — check local policy + GI cover.
Alendronic acid + Ca/vit D	70mg weekly	PO	Bone protection for prolonged steroids.

When to escalate

Any visual symptom — IV steroids now + same-day ophthalmology,Fellow-eye symptoms developing on treatment,Limb claudication / aortic involvement suspected — vascular imaging,Relapse during taper — rheumatology

Reference: BSR GCA Guidelines 2020 / EULAR imaging recommendations

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.