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Polymyalgia rheumatica without cranial ischaemic symptoms — SCE Acute Medicine MCQ

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HardMusculoskeletal systemPolymyalgia rheumatica without cranial ischaemic symptomsSCE Acute Medicine

A 69-year-old has bilateral shoulder and hip-girdle aching, morning stiffness for two hours, ESR 78 mm/hour and normal CK. There are no cranial symptoms. What is the best initial treatment?

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Correct answer: D — Start prednisolone 15 mg daily and assess response

The best answer is “Start prednisolone 15 mg daily and assess response”. This is correct because the phenotype is typical polymyalgia rheumatica without giant-cell-arteritis features. A rapid response supports but does not alone prove the diagnosis, and mimics must be reviewed. Visual-threat steroid regimens are unnecessary, biopsy is not routine for isolated PMR, and NSAID or methotrexate monotherapy is not standard induction.

Reference: BSR/BHPR guideline for polymyalgia rheumatica: https://academic.oup.com/rheumatology/article/49/1/186/1789113