Giant Cell Arteritis- Visually Asymptomatic

COVID-19 Emergency Response

Refer patient urgently to General Practice

Differential diagnosis

Migraine
Analgesic induced headache
Cluster headache
Trigeminal neuralgia

Possible management by Optometrist

Treatment

None

Advice

Urgent referral to the GP same day
Advice to General Practice
- Measure CRP (ESR if CRP not possible) and full blood count prior to starting treatment
- Start prednisolone
  - 60mg daily one week
  - 45mg daily one week
  - 30mg daily one week
  - 20mg daily one week
  - 15mg daily for one week
- Monitor response day 1 or 2 after starting 60mg of prednisolone
  - Symptoms should have dramatically responded
  - Inflammatory markers (CRP, ESR (delayed), platelets should have significantly improved
  - Thereafter monitor response by symptoms and inflammatory markers every few months till after treatment ends
- If no, or poor response, reconsider diagnosis
- Reconsider management next when patient down to 15mg daily
- If there has been a rapid improvement in symptoms and inflammatory markers, then reduce prednisolone to
  - 12.5 mg daily for one week
  - then 10mg daily for one month
  - Reduce prednisolone thereafter by 1mg a month to 5mg daily.
  - Stay on 5mg daily till anniversary
  - Then reduce by 1mg a month to zero
- If the response has been slower then
  - Reduce prednisolone by 1mg a month to 5mg daily.
  - Stay on 5mg daily till anniversary
  - Then reduce by 1mg a month to zero
- Prescribe omeprazole 20mg daily till down to less than 10mg of prednisolone
- Start on Alendronic Acid with adequate Calcium and Vitamin D supplementation
GP to commence oral steroids and refer to hospital for temporal artery ultrasound or biopsy (may not be performed by ophthalmology department if no visual symptoms: check protocol with local hospital)
If same day GP review not possible, refer urgently to ophthalmology or rheumatology, according to local guidelines.

Management Category

Urgent referral to GP
Urgent referral to ophthalmology or rheumatology, according to local guidelines

Possible management by Ophthalmologist

Steroids (with gastric protection)
Temporal artery ultrasound or biopsy to confirm the diagnosis