Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?

As with most clinical scenarios, the short answer is 'it depends'.

If a patient has cranial symptoms, elevated inflammatory markers, and suspicion for GCA is high, I do refer for temporal artery biopsy to help confirm the diagnosis. This is in line with guidelines from the American College of Rheumatology. Maz et al., PMID 34235884

Given the morbidity associated with immunosuppressive therapy for GCA, chronicity of the disease, and long term complications (such as aortic aneurysm), I highly reco...

Yes, send for biopsy but if clinical suspicion is high, treat in spite of negative biopsy.

Other red flags for GCA - temporal artery halo sign on ultrasound, MRA scoring system for external carotid branch thickening or uniform aortic wall thickening >3mm, large segment narrowing of carotid siphon or vertebral arteries prior to pica origin.