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Fibromyalgia — SCE Rheumatology MCQ

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HardOsteoarthritis and Soft Tissue RheumatologyFibromyalgiaSCE Rheumatology

A 62-year-old woman has widespread pain, fatigue, non-restorative sleep, diffuse tenderness and normal ESR, CRP, CK and thyroid function. What is the most appropriate management?

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Correct answer: D — Education, graded exercise and sleep-focused management

The best answer is “Education, graded exercise and sleep-focused management”. Education, graded exercise and sleep-focused management is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Start methotrexate with folic acid and monitoring”, “Begin high-dose glucocorticoids immediately, after safety review”, “Urgent joint aspiration and culture, after specialist assessment”, “Use NSAID therapy and physiotherapy, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations