In suspected giant cell arteritis, what is the best initial management to prevent vision loss?

• A. High-dose prednisone and low-dose aspirin
• B. IV methylprednisolone
• C. IV methylprednisolone and high-dose aspirin
• D. Treatment with corticosteroids if temporal artery biopsy abnormal

Answer: (A)

Rapid control of inflammation with high-dose glucocorticoids is essential when giant cell arteritis is suspected because irreversible vision loss can occur quickly if treatment is delayed. Starting high-dose prednisone promptly reduces arterial inflammation and improves blood flow to the optic nerve, lowering the risk of anterior ischemic optic neuropathy even before biopsy confirmation. Adding low-dose aspirin provides antiplatelet protection to reduce thrombotic occlusion in inflamed vessels, offering additional protection against vision loss and other ischemic complications. Do not wait for temporal artery biopsy results to begin treatment, since steroids can alter biopsy findings and vision protection is time-sensitive. In cases with overt or imminent vision loss, some clinicians use intravenous methylprednisolone in addition to oral steroids, but the standard initial approach for suspected GCA without immediate visual symptoms is high-dose prednisone plus low-dose aspirin, with plans for biopsy afterward if needed.