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Polymyalgia Rheumatica — UKMLA MCQ

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HardRheumatologyPolymyalgia RheumaticaUKMLAMRCGP AKTPARAMRCP Part 1

A 67-year-old is treated for presumed polymyalgia rheumatica with prednisolone 15 mg daily. After 10 days there is no meaningful improvement in morning stiffness, and CRP remains high. There are no cranial symptoms. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Reconsider the diagnosis and arrange specialist assessment

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · C = shown as D · A = shown as E

B is correct. A prompt substantial response is expected in typical PMR; absent response should trigger reassessment for mimics, occult infection, malignancy or another inflammatory disease and specialist input rather than automatic escalation. A risks masking an alternative process and uses response circularly. C treats symptoms without addressing diagnostic failure. D makes another unsupported diagnosis and abrupt withdrawal may be unsafe. E introduces specialist disease-modifying therapy before establishing what is being treated.

Reference: British Society for Rheumatology: giant cell arteritis guideline: https://academic.oup.com/rheumatology/article/59/3/e1/5714024 GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map