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136268 Medicine

A previously healthy and active 72-year-old woman presents to your office with a complaint of stiffness and pain in her neck and shoulders. The symptoms are much worse in the morning and improve throughout the day. The pain affects the soft tissues and does not appear localized to the shoulder or hip joints. She denies headache or jaw claudication. Physical examination is unrevealing; there is no inflammatory synovitis, muscle tenderness, or skin rash. Muscle strength is normal in the deltoid and iliopsoas muscle groups. She has normal range of motion of the shoulder and hip joints. Laboratory studies reveal an elevated ESR of 92 mm/h and a mild normocytic anemia. Which of the following is the best next step in management of this patient?

AEmpiric trial of prednisone 15 mg daily
BGraded exercise regimen
CMRI of bilateral shoulders
DTrapezius muscle biopsy
Medicine
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