American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the standard initial treatment for giant cell arteritis (GCA)?

Oral prednisone
Intravenous pulse glucocorticoids
Salicylates
DMARDs

The correct answer is: Oral prednisone

The standard initial treatment for giant cell arteritis (GCA) is oral prednisone. GCA is a large-vessel vasculitis that primarily affects individuals over the age of 50 and can lead to serious complications, including permanent vision loss, if not treated promptly. Oral prednisone is preferred because it provides rapid anti-inflammatory effects, which is essential in managing the symptoms of GCA and preventing complications. High doses are often initiated to suppress the inflammatory process effectively. This method allows for outpatient management and can be adjusted based on the patient's response and side effects. While other treatments such as intravenous pulse glucocorticoids may be used in certain severe cases or when there are complications like vision loss, the vast majority of patients can begin treatment with oral prednisone. Salicylates and disease-modifying antirheumatic drugs (DMARDs) are not standard initial treatments for GCA, as they do not provide the rapid control of inflammation necessary for this condition.