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Polymyalgia rheumatica — SCE Rheumatology MCQ

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EasyRheumatoid arthritisPolymyalgia rheumaticaSCE Rheumatology

A 29-year-old man has bilateral shoulder and hip girdle pain with prolonged morning stiffness. Examination shows active shoulder abduction is limited by pain but power is preserved. Investigations show ESR is 72 mm/hour and CK is normal. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: C — Polymyalgia rheumatica

Polymyalgia rheumatica is the best answer because the pattern described is most consistent with Polymyalgia rheumatica, including the distribution of symptoms and the targeted investigation results. Septic arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Granulomatosis with polyangiitis and Gout would be more appropriate in a different clinical pattern or at another point in the pathway, while Systemic sclerosis is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF