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Polymyalgia rheumatica — SCE Rheumatology MCQ

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ModerateVasculitisPolymyalgia rheumaticaSCE Rheumatology

A 69-year-old woman has bilateral shoulder and hip girdle pain, two hours of morning stiffness, raised CRP, normal CK and no true weakness. What is the most appropriate management?

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Correct answer: C — Start low-dose oral prednisolone and review response

Start low-dose oral prednisolone and review response is the single best answer because proximal pain and stiffness with raised inflammatory markers and normal CK suggests PMR. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Migraine is less suitable because it fits a different clinical pattern or a different treatment threshold; Sarcoidosis, Aspirin monotherapy and Etanercept do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: BSR/EULAR vasculitis recommendations; NICE technology appraisals; BNF