In a 74-year-old man with morning stiffness and elevated ESR, what is the best treatment option?

In the case of a 74-year-old man experiencing morning stiffness and elevated erythrocyte sedimentation rate (ESR), the presence of these symptoms and lab findings suggests an inflammatory process, possibly indicating a condition like rheumatoid arthritis or another inflammatory arthropathy.

The best treatment option in this scenario would be corticosteroids, such as prednisone, due to their effectiveness in rapidly reducing inflammation and alleviating symptoms. When patients present with significant inflammatory signs and have limitations due to their stiffness and discomfort, corticosteroids can provide quick relief.

While nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can also reduce inflammation and pain, they may not be sufficient alone for more severe symptoms and can have gastrointestinal side effects, especially in older patients. Methotrexate is often used for long-term management of chronic inflammatory conditions but does not provide the rapid response that corticosteroids do, making it less suitable for immediate symptom relief in an acute setting. Physical therapy is important as part of a comprehensive treatment plan but would not address the immediate inflammatory response.

Therefore, prednisone stands out as the best choice for quickly managing the inflammatory symptoms and improving the patient's quality of life in this context.