What is the best initial treatment for a patient experiencing bilateral shoulder pain, stiffness, and elevated sedimentation rate?

In this scenario, the patient's symptoms of bilateral shoulder pain and stiffness, coupled with an elevated sedimentation rate, suggest a possible inflammatory condition, such as polymyalgia rheumatica or another form of inflammatory arthritis. The elevated sedimentation rate indicates a systemic inflammatory response, which reinforces the likelihood of an underlying inflammatory disorder.

The best initial treatment in such cases is typically a corticosteroid, such as oral prednisone. Corticosteroids effectively reduce inflammation and are rapid acting. They provide significant relief from symptoms associated with inflammatory conditions, including pain and stiffness, allowing the patient to regain mobility. Prednisone is often started at a low dose and adjusted based on the patient's response and any side effects.

The other treatment options, while potentially useful in different contexts, do not address the underlying inflammation effectively. Acetaminophen is an analgesic and can help with pain relief, but it does not have anti-inflammatory properties. Intravenous ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) and might be employed for more severe pain or acute inflammatory conditions but is not typically used as a first-line chronic treatment due to its side effects and safety profile. Physical therapy can be beneficial, especially for improving mobility, but it does not address