مسنة عمرها ٧٧ سنة عندها ألم وتيبس في الكتفين والوركين صباحاً لأكثر من ساعة منذ شهر، وصعوبة في رفع يديها لتمشيط شعرها. مؤشرات الالتهاب مرتفعة جداً. صار عندها صداع جديد في الصدغ وألم في الفك عند المضغ. ما الأهم؟

A 77-year-old woman has had over an hour of morning pain and stiffness in shoulders and hips for a month and difficulty raising her arms to brush her hair, with very high inflammatory markers. She now has new temporal headache and jaw pain on chewing. What matters most?

1. Vigorous shoulder exercises at home
2. Urgent check for giant cell arteritis
3. Reassurance that it is normal ageing
4. Simple analgesia and review in three months

Answer: B) Urgent check for giant cell arteritis. Shoulder and hip girdle pain and stiffness with high inflammation is polymyalgia rheumatica, which may coexist with giant cell arteritis (temporal headache, jaw claudication), needing urgent steroids to prevent blindness.