American Board of Internal Medicine (ABIM) Certification Practice Exam

In addition to prednisone, what medication should high-risk patients with polymyalgia rheumatica be treated with to minimize relapse?

1. Antidepressants

2. Methotrexate

3. NSAIDs

4. Pain relievers

The correct answer is: Methotrexate

Polymyalgia rheumatica is commonly treated with corticosteroids such as prednisone; however, high-risk patients may benefit from additional treatment to minimize the risk of relapse. Methotrexate is an immunomodulatory agent that has been shown to help reduce the need for higher doses of prednisone and decrease relapse rates among those with polymyalgia rheumatica. By using methotrexate alongside prednisone, it helps manage the disease more effectively, particularly in patients who may have severe or recurrent symptoms. Methotrexate works by altering the immune response, which may stabilize the condition and prevent flare-ups. This adjunctive therapy is particularly important for high-risk patients who are prone to relapses, as it increases the chances of maintaining remission with lower doses of steroids, thus minimizing potential steroid-related side effects. Other medications listed, such as NSAIDs and pain relievers, may assist with symptom management but do not address the underlying inflammatory process or prevent relapses in polymyalgia rheumatica. Antidepressants, while important for managing mood disturbances often experienced by chronic illness patients, do not play a direct role in the treatment of polymyalgia rheumatica or in minimizing relapses.