A 72-year-old woman presents to her primary care physician with a 3-month history of aching and stiffness in her shoulders, neck, and hips. She reports that the stiffness is particularly pronounced in the morning and lasts for several hours. She also reports fatigue and decreased appetite. She denies any muscle weakness or fevers. Past medical history is significant for breast cancer which was treated 20 years ago with surgery and chemotherapy. She does not currently take any medications. On physical examination, there is restricted range of motion in the shoulders but no muscle tenderness or weakness. Laboratory tests reveal an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Which of the following is the most appropriate initial treatment for this condition?
D) Prednisone
The patient has features of polymyalgia rheumatica, including age over 50 years; bilateral aching and morning stiffness in the neck, shoulders, and hips; and elevated acute phase reactants. A prompt response to low-dose glucocorticoids, such as prednisone, is a hallmark of polymyalgia rheumatica and supports the diagnosis. Prednisone is the most appropriate initial treatment, providing rapid relief of symptoms such as aching and stiffness in the shoulders and hips.
Answer choice A: Azathioprine, is incorrect. Azathioprine is an immunosuppressant used for various autoimmune conditions but is not used in the treatment of polymyalgia rheumatica.
Answer choice B: Hydroxychloroquine, is incorrect. Hydroxychloroquine is used for conditions like lupus and rheumatoid arthritis but is not effective for polymyalgia rheumatica.
Answer choice C: Methotrexate, is incorrect. Methotrexate is used for conditions like rheumatoid arthritis but has shown mixed results in the treatment of polymyalgia. Glucocorticoids are the primary treatment modality.
Answer choice D: Sulfasalazine, is incorrect. Sulfasalazine is used for inflammatory bowel disease and rheumatoid arthritis but is not used in the treatment of polymyalgia rheumatica.
Key Learning Point
A prompt response to low-dose glucocorticoids, such as prednisone, is characteristic of polymyalgia rheumatica, providing rapid relief of symptoms and confirming the diagnosis.
