1 Presenting features · patients almost always >50
Tick every feature present. Ordered by urgency.0 sight-threatening0 cranial0 systemic
!Sight-threatening / ischaemicAny one of these raises concern for imminent sight loss.0 ticked
✓
Acute visual loss
Transient or permanent, one or both eyes
✓
Diplopia / double vision
New onset
✓
Jaw or tongue claudication
Pain on chewing — high specificity
✓
Visual disturbance
Blurring, field defect, amaurosis fugax
Sight-threatening feature ticked: see step 2 and the urgent guidance.
◐Cranial / vascularTypical cranial features of GCA.0 ticked
✓
New onset headache
Typically temporal
✓
Scalp tenderness
Including pain on brushing hair
✓
Temporal artery abnormal
Tender, thickened, reduced pulsation
✓
Neurological features
TIA, stroke, confusion
~Systemic / PMR and contextSupporting features, and anything that changes how markers read.0 ticked
✓
PMR features
Shoulder/hip girdle stiffness
✓
Constitutional symptoms
Malaise, fever, weight loss
✓
Already on steroids context
Markers may be suppressed
2 Your clinical impression · tick one
Please reflect on this case, then tick the one option that most closely matches your clinical impression.
Weigh the features above with your history, examination and what you know of this patient. Your choice, not a score, decides which BSR 2020 guidance is shown next.
BSR 2020 treats GCA as strongly suspected when, in your judgement, it is more likely than any other explanation.
↓Features recorded. Now tick the option below that best matches your clinical impression.
3 Inflammatory markers — if available
⚠ Critical marker caveats
▶Normal ESR does not exclude GCA. Up to 15% of biopsy-proven GCA cases have a normal ESR — those patients carry equal risk of sight loss.
▶Normal CRP does not exclude GCA. ~10% of GCA patients have both normal ESR and normal CRP at diagnosis. CRP is the more sensitive single marker (~87% vs ~84%).
▶Plasma viscosity (PV) is the primary marker in NHS Grampian. PV and ESR each produce ~13% false negatives independently.
▶Steroids suppress markers rapidly. Normal markers must not downgrade suspicion if patient is on corticosteroids.
ESR (mm/hr)Significantly raised ≥80 mm/hr · Normal does not exclude GCA
Steroid effect flagged: All markers may be suppressed. Normal results cannot downgrade suspicion.
All markers within normal range. This does not exclude GCA. Clinical features and judgement take precedence.
Guideline reference only. Relevant BSR 2020 and NHS Grampian guidance for this presentation. All clinical decisions remain with the responsible clinician; this tool does not make or drive them.
Also consider: tests to exclude mimics
In addition to the bloods in local guidance, and guided by the clinical picture, consider these to exclude conditions that can mimic GCA / PMR: inflammatory myopathy, rheumatoid arthritis, connective tissue disease, myeloma and other malignancy.
CKAnti-CCPANAMyeloma screen serum electrophoresis + free light chainsPSA menCA-125 women
Don't delay urgent steroids or same-day referral while waiting for these.
Loading guideline reference...
+ Further guideline reference · NHS Grampian local guidance