A 52-year-old woman presents with widespread musculoskeletal pain for over a year, fatigue, non-restorative sleep, and multiple tender points on examination. Her ESR is 12 mm/hr, CRP is normal, ANA is negative, and there is no synovitis. She reports similar symptoms in her mother. Which medication is recommended as first-line pharmacologic therapy for this condition per current guidelines?
- A Prednisone 10 mg daily
- B Hydroxychloroquine
- C Duloxetine ✓
- D Methotrexate
Correct answer: C. Duloxetine
Explanation
This presentation is classic fibromyalgia, diagnosed by widespread pain for over 3 months with associated fatigue, sleep disturbance, and cognitive symptoms in the absence of inflammatory markers or synovitis. First-line pharmacologic therapy includes duloxetine (SNRI), milnacipran, or pregabalin. Corticosteroids, hydroxychloroquine, and methotrexate are not effective for fibromyalgia and the normal inflammatory markers rule out an autoimmune/inflammatory etiology.
Reference: Rheumatology (Hochberg), 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.