American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended initial treatment for polymyalgia rheumatica?

1. High-dose prednisone

2. Low-dose prednisone

3. Non-steroidal anti-inflammatory drugs

4. Intravenous corticosteroids

The correct answer is: Low-dose prednisone

The recommended initial treatment for polymyalgia rheumatica is low-dose prednisone. This condition is characterized by symptoms of pain and stiffness in the shoulder and pelvic areas, often occurring in older adults. Low-dose corticosteroids like prednisone are effective in rapidly alleviating these symptoms and improving function. Starting with a low dose minimizes potential adverse effects while still providing sufficient anti-inflammatory action. The typical initial dosage is often around 10 to 20 mg daily, with adjustments as needed based on the patient's response. Most patients experience significant improvement in their symptoms within a few days of starting treatment. Additionally, using low doses is beneficial for long-term management as it allows for tapering of the medication once symptoms are controlled, reducing the risk of steroid-related complications. Higher doses of prednisone might be considered in more severe presentations but are not the first line due to increased risk of side effects. Other treatment options, such as NSAIDs, may help relieve discomfort but are generally not as effective in controlling the hallmark symptoms of polymyalgia rheumatica. Similarly, intravenous corticosteroids are typically reserved for more acute or severe inflammatory conditions rather than initial treatment for this specific diagnosis.