Vasculitis Syndromes MCQ — NEET PG Practice Question | NEETPGAI
Vasculitis Syndromes
easy
microscope Pathology
A 58-year-old man presents with sudden onset of severe headache, jaw claudication, and visual disturbances. ESR is 92 mm/h and temporal artery biopsy confirms granulomatous inflammation. What is the drug of choice for immediate management?
This patient presents with classic features of giant cell arteritis (GCA): age >50, headache, jaw claudication, visual symptoms, elevated ESR, and confirmatory temporal artery biopsy showing granulomatous inflammation.
Drug of Choice: Corticosteroids (Prednisolone)
Key Point
Corticosteroids are the gold standard and ONLY first-line therapy for GCA. High-dose prednisolone must be initiated immediately to prevent irreversible vision loss.
High-YieldNEET PG
Initial dose: Prednisolone 40–60 mg daily (or equivalent methylprednisolone IV 500–1000 mg daily if vision-threatening symptoms)
Duration: Gradual taper over 12–24 months based on clinical response and ESR normalization
Steroid-Sparing Agents (Adjunctive, Not First-Line)
Table
Agent
Role
Timing
Methotrexate
Steroid-sparing agent
Added after 2–4 weeks if high steroid requirement
Azathioprine
Second-line steroid-sparer
Reserved for steroid intolerance
Tocilizumab (IL-6 inhibitor)
Emerging steroid-sparer
Recent evidence; not first-line
Clinical Pearl
Vision loss in GCA is a medical emergency. Corticosteroids must be started BEFORE biopsy results if clinical suspicion is high (biopsy can be done within 1–2 weeks without delaying treatment).
Warning
Delaying corticosteroids while awaiting biopsy or using immunosuppressants alone risks permanent blindness — this is a common exam trap.
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