A 72-year-old woman who lives alone and is mildly frail (Clinical Frailty Scale 5) presents with 6 weeks of bilateral shoulder and hip pain, morning stiffness lasting 90 minutes, difficulty rising from a chair, and a 2 kg weight loss. She has hypertension treated with ramipril. She has no headache, scalp tenderness, jaw claudication or visual symptoms; temporal arteries are normal on examination, and shoulder movement is limited by pain but muscle strength is normal. Laboratory results show ESR 82 mm/h (0-30), CRP 56 mg/L (less than 8), hemoglobin 108 g/L (115-155), eGFR 68 mL/min/1.73 m2; creatine kinase and TSH are normal and rheumatoid factor is negative.
| Heart rate | 78/min |
| Respiratory rate | 16/min |
| Temperature | 37.2 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 138/80 mm Hg |
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