skip to main content

Polymyalgia rheumatica — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatology/Allergy/ImmunologyPolymyalgia rheumaticaABIM Board

A 70-year-old woman has eight weeks of bilateral shoulder and hip-girdle aching, morning stiffness lasting 90 minutes, ESR 68 mm/h, normal CK, and normal objective strength. She has no headache, jaw claudication, or visual symptoms. Infection and inflammatory arthritis have been reasonably excluded. What is the most appropriate initial treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Start prednisone 15 mg daily and taper according to response

The best answer is “Start prednisone 15 mg daily and taper according to response”. The presentation is typical PMR without evidence of cranial ischemia, so low-dose prednisone—often 10 to 15 mg/day—is appropriate, with subsequent tapering and toxicity prevention. Pulse glucocorticoids are reserved for threatened ischemic complications such as visual GCA. NSAIDs are usually inadequate, while steroid-sparing therapy is selected for relapse or substantial glucocorticoid risk rather than replacing initial treatment in this uncomplicated case.

Reference: American College of Rheumatology: Polymyalgia Rheumatica: https://rheumatology.org/patients/polymyalgia-rheumatica