Rheumatology Question 94

A 74-year-old woman is evaluated during a follow-up visit for polymyalgia rheumatica diagnosed 8 weeks ago after developing shoulder and hip girdle pain and morning stiffness. Symptoms resolved on prednisone, 15 mg/d. She feels well and reports no headache, jaw claudication, visual changes, or recurrence of myalgia or stiffness. History is significant for type 2 diabetes mellitus and hypertension. Medications are metformin, lisinopril, and prednisone, which has been tapered to 10 mg/d. On physical examination, temperature is normal, blood pressure is 140/80 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. BMI is 31. There is no temporal tenderness or induration. No carotid or subclavian bruits are present. Good range of motion without pain in the shoulders and hips is noted. Proximal strength is normal. 

Which of the following is the most appropriate management at this time?

A Increase prednisone

B Increase prednisone and add methotrexate

C Schedule temporal artery biopsy

D Continue current treatment

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