A 68-year-old woman presents with bilateral aching of the shoulders, neck, and hips for 3 months with morning stiffness lasting over 45 minutes. ESR is 88 mm/hr, CRP elevated, and rheumatoid factor is negative. There is no synovitis or weakness. The most appropriate initial treatment is:
- A High-dose methotrexate weekly
- B Low-dose prednisone 10–20 mg/day ✓
- C NSAIDs alone
- D Hydroxychloroquine 400 mg daily
Correct answer: B. Low-dose prednisone 10–20 mg/day
Explanation
This presentation is classic for polymyalgia rheumatica (PMR), characterized by bilateral shoulder and pelvic girdle aching with elevated inflammatory markers in patients over 50. Low-dose prednisone (10–20 mg/day) produces a dramatic response within days, which is both diagnostic and therapeutic; failure to respond should prompt reconsideration of the diagnosis. PMR is closely associated with giant cell arteritis, and patients should be monitored for headache or visual symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.