An 82-year-old woman is evaluated for a flare of polymyalgia rheumatica manifested by aching in the shoulders and hips that began 2 weeks ago. She als

[Kathryn]

#march2020mccqe1

An 82-year-old woman is evaluated for a flare of polymyalgia rheumatica manifested by aching in the shoulders and hips that began 2 weeks ago. She also has fatigue and malaise. She was diagnosed with polymyalgia rheumatica 8 months ago. At that time, she was prescribed prednisone, 20 mg/d; her symptoms promptly resolved; and her prednisone dosage was gradually tapered. Four months ago, her prednisone dosage was decreased from 7.5 mg/d to 5 mg/d, and her symptoms returned. Her prednisone dosage was then increased to 10 mg/d followed by a slow taper of this agent. Her prednisone dosage was most recently decreased from 7 mg/d to 6 mg/d, which is her current dosage. She also takes calcium and vitamin D supplements and a bisphosphonate.
On physical examination, vital signs are normal. Range of motion of the shoulders, neck, and hips elicits mild pain. There is no temporal artery tenderness. Which of the following is the most appropriate treatment for this patient?
(A) Increase prednisone to 20 mg/d
(B) Increase prednisone to 7.5 mg/d; add methotrexate
(C) Increase prednisone to 20 mg/d; add methotrexate
(D) Increase prednisone to 7.5 mg/d; add infliximab