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Polymyalgia Rheumatica — RACP Adult Medicine MCQ

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HardRheumatologyPolymyalgia RheumaticaRACP Adult Medicine

A 65-year-old with polymyalgia rheumatica has repeated relapses below prednisolone 7.5 mg and has developed diabetes and fragility fractures. Giant-cell arteritis symptoms are absent. Which steroid-sparing strategy is most established?

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Correct answer: B — Add low-dose weekly methotrexate with folate and safety monitoring while attempting a slower glucocorticoid taper

The best answer is “Add low-dose weekly methotrexate with folate and safety monitoring while attempting a slower glucocorticoid taper”. Methotrexate is the most established conventional glucocorticoid-sparing option for relapsing PMR or substantial steroid toxicity, though benefit is modest and monitoring is required. Cyclophosphamide and rituximab are not routine PMR treatment, and abrupt steroid replacement risks relapse or adrenal insufficiency. Newer biologic options require specialist selection rather than displacing the standard initial steroid-sparing approach automatically.

Reference: Australian Prescriber: Prescribing for polymyalgia rheumatica: https://australianprescriber.tg.org.au/articles/prescribing-for-polymyalgia-rheumatica.html