American Board of Internal Medicine (ABIM) Certification Practice Exam

In GCA patients experiencing visual loss, what is the recommended treatment?

1. Oral corticosteroids

2. Intravenous (IV) pulse glucocorticoids

3. Topical therapies

4. NSAIDs

The correct answer is: Intravenous (IV) pulse glucocorticoids

In patients with giant cell arteritis (GCA) who are experiencing visual loss, intravenous (IV) pulse glucocorticoids are the recommended treatment. This approach is vital due to the urgent nature of visual complications associated with GCA, which can lead to permanent blindness if not treated aggressively and swiftly. IV pulse glucocorticoids, such as methylprednisolone, are used because they provide a higher dose of corticosteroids directly into the bloodstream, allowing for more rapid and potent anti-inflammatory effects compared to oral administration. This is particularly crucial in cases of visual loss, as the goal is to quickly reduce inflammation and prevent further ocular damage caused by the underlying vasculitis. Oral corticosteroids are effective in managing GCA overall but may not work fast enough to avert vision loss in acute cases. Other options like topical therapies and NSAIDs are not appropriate for treating GCA, especially when dealing with severe manifestations like visual loss, as they do not exert the necessary immunosuppressive effects on the vasculitis. Thus, in this specific scenario, intravenous glucocorticoids stand out as the most appropriate and immediate treatment to protect vision and manage the condition effectively.