In polymyalgia rheumatica, what is the first-line treatment to initiate?

• A. Low-dose corticosteroids (prednisone 10-20 mg daily)
• B. NSAIDs
• C. High-dose methotrexate
• D. Biologic therapy

Answer: (A)

Polymyalgia rheumatica responds best to rapid suppression of inflammation with a low-dose glucocorticoid. Starting treatment with prednisone around 10–20 mg daily usually yields swift relief of proximal shoulder and hip girdle pain and stiffness, often within 1–3 days, allowing meaningful improvement in function. This quick response is what makes low-dose corticosteroids the first-line choice, with a gradual taper over months depending on symptoms and relapse risk.

NSAIDs may help briefly for comfort, but they don't adequately control the underlying inflammatory process in PMR and are not sufficient as the main therapy. Higher-risk or longer-term steroid-sparing strategies like methotrexate or biologic agents are typically reserved for patients who relapse despite steroids, have contraindications to steroids, or require very long courses due to ongoing disease activity; they are not the initial treatment.