A 72-year-old woman complains of severe aching and morning stiffness in both shoulders and hips for 2 months. She has difficulty rising from a chair. ESR is 65 mm/hr. Creatine kinase is normal. There is no muscle weakness on examination. What is the most appropriate initial treatment?

• A Prednisone 15 mg daily ✓
• B Prednisone 60 mg daily
• C Naproxen 500 mg twice daily
• D Methotrexate 15 mg weekly

Explanation

Polymyalgia rheumatica is diagnosed by bilateral shoulder and hip girdle pain with elevated inflammatory markers and absence of weakness. It responds dramatically to low-dose corticosteroids (15-20 mg prednisone). High-dose steroids are reserved for giant cell arteritis. NSAIDs are less effective. Methotrexate is a steroid-sparing agent, not initial therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.