skip to main content

Adult-onset Still's disease — SCE Rheumatology MCQ

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

HardPregnancy in rheumatic disease, rare conditionsAdult-onset Still's diseaseSCE Rheumatology

A patient with correctly diagnosed polymyalgia rheumatica relapses with recurrent bilateral girdle stiffness and raised CRP after prednisolone falls from 7.5 to 5 mg. Infection and GCA symptoms are absent. What is the best immediate plan?

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

Reveal the answer and explanation

Correct answer: A — Previous effective prednisolone dose with slower re-taper

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

E is correct. A genuine isolated PMR relapse is managed by increasing prednisolone to the previously effective dose, then repeating a slower taper. Recurrent relapse, cumulative toxicity or inability to taper should trigger diagnostic review and steroid-sparing discussion. A leaves active disease untreated. B uses a GCA-level dose without GCA features. C risks adrenal insufficiency and undertreatment. D is disproportionate and unsupported. New headache, jaw claudication, visual symptoms or vascular features would instead require urgent GCA assessment and should never be folded into routine PMR relapse care.

Reference: NICE CKS: polymyalgia rheumatica — management: https://cks.nice.org.uk/topics/polymyalgia-rheumatica/management/management/