🏥 USMLE Exam Prep

An 80-year-old woman presents with bilateral shoulder and hip pain and stiffness that has been ongoing for 3 months. The pain is worse in the morning, lasting for more than 45 minutes, and limits her ability to dress herself. She also reports mild fatigue. Physical examination reveals tenderness to palpation over the shoulders and hips, but no muscle weakness. Laboratory tests show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). What is the most appropriate initial treatment?

A High-dose methotrexate
B Nonsteroidal anti-inflammatory drugs (NSAIDs)
C Low-dose oral corticosteroids
D Physical therapy and exercise regimen

✓ Correct Answer: Option C

This patient's symptoms (age >50, bilateral shoulder/hip girdle pain, morning stiffness >45 mins, elevated inflammatory markers) are classic for polymyalgia rheumatica (PMR). PMR responds dramatically to low-dose oral corticosteroids, which is the cornerstone of initial treatment.

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