A 62-year-old woman presents with bilateral temporal headache, jaw claudication, and a tender, non-pulsatile right temporal artery. ESR is 98 mm/hr, CRP 45 mg/L. The IMMEDIATE next step is:
- A Temporal artery biopsy before starting steroids
- B Start high-dose prednisolone 40–60 mg/day immediately, then biopsy within 2 weeks ✓
- C Start low-dose aspirin and arrange outpatient biopsy
- D MRI orbit to exclude compressive optic neuropathy
Correct answer: B. Start high-dose prednisolone 40–60 mg/day immediately, then biopsy within 2 weeks
Explanation
Giant cell arteritis (GCA) is a medical emergency because untreated it causes irreversible visual loss (ischemic optic neuropathy) in up to 20% of cases. High-dose corticosteroids (prednisolone 40–60 mg/day, or IV methylprednisolone if visual symptoms) must be started immediately without waiting for biopsy. Biopsy should be performed within 1–2 weeks, as histological changes persist for at least 2 weeks after starting steroids. Delaying treatment for biopsy risks bilateral blindness.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.