A 66-year-old female presents with severe morning stiffness and aching pain in the shoulder and pelvic girdles without muscle weakness. ESR is 75 mm/hr. What is the classic therapeutic response?

Answer and explanation

Correct answer: B. Rapid clinical remission with low-dose oral prednisone

  1. Step 1: Symmetrical proximal aching and stiffness of the shoulder and hip girdles in an individual over 50 years with elevated inflammatory markers indicates polymyalgia rheumatica (PMR).
  2. Step 2: A prompt, dramatic clinical improvement within 24 to 72 hours of starting low-dose oral prednisone (15 to 20 mg daily) is a hallmark of PMR that supports the diagnosis.
Answer
Rapid clinical remission with low-dose oral prednisone.
Why not the others: PMR is exquisitely responsive to low-dose glucocorticoids; lack of response should prompt reconsideration of the diagnosis. Cyclophosphamide is a cytotoxic agent for severe systemic necrotizing vasculitis, not PMR. Plasma exchange has no therapeutic indication in polymyalgia rheumatica.

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