Which clinical finding is most consistent with polymyalgia rheumatica?

Polymyalgia rheumatica is characterized primarily by pain and stiffness in the proximal muscles and joints, particularly affecting the shoulders and hips. One of the hallmark features of this condition is the presence of elevated inflammatory markers, notably erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These abnormalities reflect the underlying inflammatory process associated with polymyalgia rheumatica.

High ESR levels indicate systemic inflammation, which is typical in this condition. Although patients may experience stiffness and discomfort, especially in the morning, the key laboratory finding that supports the diagnosis is the elevation of inflammatory markers like ESR. This distinguishes polymyalgia rheumatica from other conditions that may present with similar clinical features but without such a significant inflammatory response.

The other options may present in various conditions but are less specific to polymyalgia rheumatica. Proximal limb weakness, for instance, is more indicative of conditions like myositis rather than polymyalgia rheumatica, which primarily involves pain and stiffness rather than true weakness. Decreased range of motion can occur due to pain but is not as characteristic as the high ESR level. Severe muscle pain at rest is also not a defining symptom; pain with activity or in the morning after rest