When should I consider referring a patient with suspected giant cell arteritis to a specialist?

Refer a patient with suspected giant cell arteritis (GCA) urgently to a specialist if GCA is strongly suspected based on clinical judgement, as it is a medical emergency due to the risk of sudden irreversible sight loss and other serious complications.

Specifically:

• If the patient has new visual loss (transient or permanent) or double vision, arrange an urgent same-day assessment by an ophthalmologist.
• For all other suspected GCA cases without visual symptoms, discuss urgently with a specialist and refer using a fast-track local GCA pathway, aiming for specialist assessment on the same working day if possible, and in all cases within 3 working days.
• Start high-dose glucocorticoid treatment immediately when GCA is strongly suspected, without waiting for blood test results.

These steps are critical to prevent serious complications such as permanent vision loss.

Blood tests (full blood count, CRP, ESR) may be arranged to support diagnosis but should not delay referral.