Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with bilateral shoulder and/or pelvic girdle pain and stiffness, lasting >45 minutes in the morning. Symptoms are progressive, associated with constitutional symptoms including fatigue, low-grade fever, and unintentional weight loss. Denies focal neurological deficits, muscle weakness (suggestive of myositis), or symptoms of giant cell arteritis (jaw claudication, visual disturbances, or scalp tenderness).
Clinical Examination Findings
General: Patient appears uncomfortable with movement. Musculoskeletal: Tenderness to palpation noted over the shoulder and hip girdles. Range of motion (ROM) is limited by pain, though passive ROM is generally preserved. No objective muscle weakness on manual muscle testing (MMT 5/5). No synovitis or joint swelling noted. Neurological: Deep tendon reflexes are intact and symmetric. No signs of proximal muscle atrophy.
Treatment Protocol
Initiate oral Prednisone 15 mg daily. Monitor for rapid clinical response (typically within 1-2 weeks). Plan for gradual taper of corticosteroids based on clinical symptoms and inflammatory markers (ESR/CRP). Prescribe calcium and Vitamin D supplementation for bone protection. Consider proton pump inhibitor (PPI) for gastric prophylaxis. Advise regular follow-up to monitor for relapse or development of Giant Cell Arteritis.