Which finding best supports the diagnosis of polymyalgia rheumatica?

Which finding best supports the diagnosis of polymyalgia rheumatica?

• A. Pain and stiffness in the neck and bilateral shoulder and pelvic girdles with ESR > 50 mm/hr
• B. Proximal muscle weakness with preserved reflexes
• C. Distal numbness in the feet
• D. Recurrent rash on the trunk

Answer: (A)

Polymyalgia rheumatica presents in older adults with inflammatory pain and stiffness in the proximal shoulder and hip girdles, often with morning stiffness and elevated inflammatory markers. The described finding—pain and stiffness in the neck and bilateral shoulder and pelvic girdles with an ESR > 50 mm/hr—best supports PMR because it captures both the typical distribution and the inflammatory marker elevation that accompany the syndrome. Proximal weakness with preserved reflexes would hint more toward an inflammatory myopathy rather than PMR; distal numbness suggests neuropathy; and a trunk rash points to a dermatologic or systemic condition rather than PMR.

Polymyalgia rheumatica presents in older adults with inflammatory pain and stiffness in the proximal shoulder and hip girdles, often with morning stiffness and elevated inflammatory markers. The described finding—pain and stiffness in the neck and bilateral shoulder and pelvic girdles with an ESR > 50 mm/hr—best supports PMR because it captures both the typical distribution and the inflammatory marker elevation that accompany the syndrome. Proximal weakness with preserved reflexes would hint more toward an inflammatory myopathy rather than PMR; distal numbness suggests neuropathy; and a trunk rash points to a dermatologic or systemic condition rather than PMR.