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Polymyalgia rheumatica — MCCQE Part 1 MCQ

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ModerateJoint PainPolymyalgia rheumaticaMCCQE Part 1

72-year-old woman presents with bilateral shoulder and hip girdle pain. Morning stiffness lasts 2 hours and ESR is elevated; no headache or visual symptoms. Which of the following is the most appropriate next step?

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Correct answer: C — Start low-dose corticosteroids and screen for giant cell arteritis symptoms

Start low-dose corticosteroids and screen for giant cell arteritis symptoms is best because proximal pain/stiffness with raised inflammatory markers suggests PMR. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Ask about jaw claudication and visual symptoms at each visit.

Reference: Canadian Rheumatology Association guidance