Synopsis
Recognise cranial, ocular and large-vessel giant-cell arteritis promptly, give glucocorticoid before diagnostic delay causes blindness, secure ultrasound or biopsy evidence, and reduce relapse and steroid toxicity through structured specialist care.
- Suspect GCA in anyone over fifty with new headache, scalp tenderness, jaw or tongue claudication, visual symptoms, abnormal temporal artery, PMR symptoms or unexplained inflammatory illness.
- Ask every suspected patient explicitly about transient visual loss, diplopia and permanent change; visual symptoms move care to an immediate same-day pathway.
- Give prednisolone 40–60 mg orally immediately for strongly suspected uncomplicated cranial GCA; do not wait for ESR, CRP, ultrasound or biopsy.
Key red flags
Amaurosis fugax, diplopia, colour or field loss and new visual impairment require immediate treatment and same-day ophthalmic assessment.
Amaurosis fugax, diplopia, field or colour loss and sudden permanent visual change requires immediate glucocorticoid and ophthalmic care.
Investigation priorities
Identify threatened sight, cranial arterial abnormality and large-vessel asymmetry before treatment or transfer.
Management branches
Clinical suspicion of GCA is strong, with no current visual symptom.
- Draw baseline bloods and assess visual, neurological and vascular status without delaying the first glucocorticoid dose.
- Start prednisolone 40–60 mg orally once daily and arrange fast-track rheumatology review and ultrasound within days.
Key medicines
Prednisolone for uncomplicated GCAStart 40–60 mg orally once daily immediately, maintain until symptoms and inflammatory markers resolve, then taper over at least twelve months using the specialist schedule.
Intravenous methylprednisolone for visual ischaemiaGive 500 mg–1 g intravenously once daily for up to three consecutive days, followed by high-dose oral prednisolone under same-day specialist care.