Giant Cell Arteritis (Temporal Arteritis) — Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Suspected GCA?
   Age >50 with temporal headache/jaw claudication ± visual symptoms — suspected GCA? (Medium/large-vessel vasculitis in those >50 (often with polymyalgia rheumatica). Cranial type: new headache, scalp/temporal artery tenderness, jaw claudication (pain on chewing, high risk of blindness); ocular type: transient monocular vision loss/diplopia → can progress to permanent blindness (anterior ischemic optic neuropathy), an ophthalmic emergency. Markedly raised ESR/CRP, raised platelets. Diagnosis: temporal artery biopsy (gold standard, can remain positive 1–2 weeks after steroids) or temporal artery ultrasound 'halo sign'.)
   • Suspected GCA (raised ESR/CRP or typical symptoms) → Suspected GCA → immediate high-dose steroids
   • Does not fit → Does not fit · differentiate + follow up
2. [End] Does not fit · differentiate + follow up
   Evaluate other causes of headache/visual symptoms/jaw pain (migraine, temporomandibular joint, other vasculitis/infection) along the appropriate pathway; keep suspicion in those >50 with raised ESR/CRP, with rheumatology/ophthalmology consult and temporal artery ultrasound/biopsy if needed.
3. [End] Suspected GCA → immediate high-dose steroids
   Start high-dose corticosteroids immediately on clinical suspicion, do not wait for biopsy: with visual involvement → IV methylprednisolone pulse 500–1000 mg/day × 3 days then oral prednisone ~1 mg/kg; without visual symptoms → oral prednisone 40–60 mg/day. Add tocilizumab (IL-6) as a steroid-sparing agent, low-dose aspirin if appropriate, PPI/bone protection. Arrange temporal artery ultrasound/biopsy within 1–2 weeks to confirm; taper slowly, follow ESR/CRP + symptoms; protect the fellow eye.

Source guidelines & references

• Giant cell arteritis (EULAR/ACR guidelines; MSD Manual)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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