Adults
Giant cell arteritis (GCA)
New headache, jaw claudication or visual symptoms in someone 50 or older. Start glucocorticoids the same day and call rheumatology.
What to look for
- Age 50 or older with a new headache, scalp tenderness or jaw claudication
- Visual symptoms: transient monocular loss (amaurosis fugax), diplopia or sudden vision loss
- Shoulder and hip girdle aching (PMR symptoms), fever, weight loss or fatigue
- Arm claudication, unequal arm blood pressures or bruits suggest large-vessel involvement
- ESR and CRP are usually raised, but normal values do not rule GCA out
What to do
- Start glucocorticoids on the day of clinical suspicion; don't wait for biopsy or imaging. A typical starting dose is prednisone 40–60 mg daily.
- With visual loss or amaurosis, arrange same-day ophthalmology or emergency care. IV methylprednisolone is often used.
- Contact rheumatology the same day. EULAR 2025 treats suspected cranial GCA as an emergency, with urgent specialist referral within 24 hours of presentation, through a fast-track pathway where one exists.
- Confirm the diagnosis promptly. Use temporal and axillary artery ultrasound where a fast-track service exists, or temporal artery biopsy. Ultrasound changes can fade within days of starting glucocorticoids.
- Send ESR, CRP, CBC and a metabolic panel including glucose before or as treatment starts.
Good to know
- Ask every patient with PMR about headache, jaw pain and visual symptoms. Up to about 1 in 5 people with PMR may also have GCA, sometimes without cranial symptoms.
- A typical glucocorticoid plan tapers to 15–20 mg daily by months 2–3 (EULAR 2025). Steroid-sparing options include tocilizumab and upadacitinib (FDA-approved for GCA in 2025), with methotrexate as an alternative.
About this urgency level
Call rheumatology directly. Many of these need the emergency department or admission, and treatment often starts before the specialist visit.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.