Transient visual loss or diplopia combined with jaw claudication will predict same-day ocular ischemic GCA complications better than inflammatory markers alone in fast-track suspected GCA pathways.

Why this is plausible

• Visual ischemic complications are the outcome clinicians most need to prevent urgently.
• ESR and CRP help, but they are supportive rather than decisive when cranial ischemic symptoms are already present.
• Cranial ischemic symptom clusters may carry more immediate triage value than biomarker elevation alone.

Testable prediction In a prospective fast-track GCA cohort, a model containing transient visual symptoms + jaw claudication + temporal artery abnormality + age will show better discrimination for imminent ocular ischemic events than a model using ESR + CRP + platelet count alone.

Suggested study design

• Consecutive adults referred for suspected GCA
• Primary endpoint: same-day or 7-day ocular ischemic complication, including arteritic AION or persistent visual loss
• Compare clinical-symptom model vs lab-only model with AUROC, calibration slope, and decision-curve analysis

Falsification This hypothesis fails if inflammatory-marker-only models match or exceed the symptom-rich model for discrimination and net benefit.

References

1. Hayreh SS, Podhajsky PA, Zimmerman B. JAMA. 1998;280(4):385-391. DOI: 10.1001/jama.280.4.385
2. Maz M, Chung SA, Abril A, et al. Arthritis Rheumatol. 2021;73(8):1349-1365. DOI: 10.1002/art.41774
3. Czihal M, et al. Rheumatol Int. 2019;39(12):2095-2102. DOI: 10.1007/s00296-019-04422-5