A 65-year-old man presents with a 3-week history of bitemporal headache, jaw claudication, and ESR 92 mm/hr. Temporal artery biopsy is being arranged. What is the most appropriate immediate action?
- A Start high-dose prednisolone immediately without waiting for biopsy results ✓
- B Await biopsy result before starting corticosteroids
- C Start tocilizumab and delay prednisolone
- D Order CT-PET scan before any treatment
Correct answer: A. Start high-dose prednisolone immediately without waiting for biopsy results
Explanation
Giant cell arteritis (GCA) is a medical emergency; treatment must not be delayed waiting for biopsy, as visual loss from anterior ischaemic optic neuropathy can occur rapidly and is irreversible. High-dose prednisolone (1 mg/kg/day, up to 60 mg) is started immediately. Temporal artery biopsy remains positive for up to 2 weeks after initiating corticosteroids, so the diagnostic window is not lost. Tocilizumab (IL-6 inhibitor) is used as a steroid-sparing agent in established GCA, not as initial monotherapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.