Her medical history was notable for breast cancer, which was now in remission, asthma, irritable bowel syndrome and hyperlipidemia with a history of statin intolerance. Medications included a fluticasone inhaler twice daily, an albuterol inhaler as needed, and calcium and vitamin D supplements.
She had no family history of autoimmune disease, PMR or vasculitis. Her social history was significant for three to four years of smoking in her 20s and occasional alcohol use. The physical exam was normal, except for limited active abduction of the shoulders.
The patient was advised to start 15 mg of prednisone daily for a suspected diagnosis of PMR, but she refused. She expressed apprehension of taking any prescription medications and was adamant she wanted to “control the inflammation with dietary changes.”