A patient with biopsy-confirmed temporal arteritis should be treated with which agent as first-line therapy?

• A. Cyclosporine
• B. Prednisone
• C. Ibuprofen
• D. Methotrexate

Answer: (B)

Systemic corticosteroids are essential because giant cell arteritis is an inflammatory vasculitis that can cause sudden, irreversible vision loss if not treated promptly. Prednisone is the standard first-line therapy because it rapidly suppresses arterial inflammation and reduces the risk of vision complications. A typical starting dose is about 40–60 mg daily, with plans to taper over weeks to months as symptoms improve and inflammatory markers normalize. If there are signs of impending or actual visual loss, initiating high-dose intravenous methylprednisolone (1 gram daily for 3 days) followed by oral prednisone provides the fastest control of inflammation. Biopsy confirmation does not change the need for prompt treatment, and therapy should not be delayed while awaiting results. Other drugs like ibuprofen do not address the vasculitis; cyclosporine is not first-line; methotrexate may be considered later as a steroid-sparing agent or in refractory cases.