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PMR initial treatment — SCE Rheumatology MCQ

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ModerateVasculitisPMR initial treatmentSCE Rheumatology

A 71-year-old man has classic bilateral shoulder and hip stiffness without cranial symptoms. Examination shows no synovitis or weakness is present. Investigations show ESR is 64 mm/hour and CK is normal. What is the most appropriate management?

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Correct answer: D — Start low-dose oral prednisolone with planned taper

Start low-dose oral prednisolone with planned taper is the best management step because the vignette describes active or organ-threatening vasculitis. The tempting alternatives either delay sight- or organ-saving therapy or treat a different condition. In vasculitis, treatment urgency is determined by organ threat as much as by diagnostic certainty.

Reference: EULAR ANCA-associated vasculitis recommendations; BSR guideline; BNF