## Diagnosis: Giant Cell Arteritis (Temporal Arteritis) **Key Point:** This patient has classic GCA with the triad of headache, jaw claudication, and visual symptoms, confirmed by positive temporal artery biopsy showing granulomatous inflammation with giant cells. **High-Yield:** GCA is a large-vessel vasculitis affecting the aorta and its major branches, with predilection for the temporal and ophthalmic arteries. The ESR >90 mm/h and elevated CRP are typical. ### Management Strategy **Clinical Pearl:** Once GCA is confirmed histologically, immediate high-dose corticosteroid therapy is essential to prevent irreversible vision loss from arteritic anterior ischemic optic neuropathy (AAION). | Feature | Standard Approach | |---------|-------------------| | **Initial therapy** | High-dose IV methylprednisolone 500–1000 mg daily × 3–5 days (if vision-threatening symptoms) OR oral prednisolone 40–60 mg daily | | **Transition** | Switch to oral prednisolone after IV pulse therapy | | **Tapering timeline** | Gradual reduction over 12–24 months based on clinical response and inflammatory markers | | **Adjunctive therapy** | Low-dose aspirin (75 mg daily) reduces risk of thrombotic complications | | **Steroid-sparing agents** | Methotrexate or tocilizumab considered in steroid-dependent or intolerant patients | **Mnemonic:** **GCA-VISION** — Giant Cell Arteritis requires Vigilant Immediate Steroid Intervention Or Necrosis (of optic nerve) ### Why This Answer Intravenous methylprednisolone followed by oral prednisolone tapering is the gold standard for confirmed GCA, especially when vision-threatening symptoms are present. This approach rapidly suppresses inflammation and prevents permanent blindness. [cite:Harrison 21e Ch 318]
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