NUR 555 STUDY QUESTIONS AND ANSWERS |
2026 UPDATE | WITH COMPLETE SOLUTIONS
Polymyalgia rheumatica pathophys
IL-6 mediated inflammation of synovium and periarticular tissue
Polymyalgia rheumatica clinical presentation
Age over 50 years
Markedly elevated ESR and CRP
Pain and stiffness in shoulders and hips lasting for several weeks without other explanation
Polymyalgia rheumatica commonly occurs with
giant cell arteritis but not always
Polymyalgia rheumatica history
Profound stiffness and pain in shoulders, hip, low back
Fatigue
-trouble combing their hair, putting on a coat, or rising from a chair
Polymyalgia rheumatica is NOT
Muscle weakness (inflammation or nerve infarction)
Polymyalgia rheumatica PE
No muscle weakness
Decreased active ROM in shoulders/hips
,Low grade fever
Weight loss
Polymyalgia rheumatica initial diagnostics
ESR >30
CRP >0.5
Negative autoantibodies
US/MRI shows bursitis tenosynovitis
Polymalgia rheumatica differential dx
RA
Late-onset spondyloarthritis
Myopathies
Hypothyroidism
Malignancy or infx
Polymyalgia rheumatica management
Low dose prednisone
anti-IL-6Ra antibody, Sarilumab for refractory
Polymyalgia rheumatica drug classifications of all medications
corticosteroids
Sarilumab is a biologic DMARD, monoclonal antibody (anti-IL-6Ra antibody)
Prednisolone management of polymyalgia rheumatica
,Low dose
10-20mg/day orally
Should see dramatic improvement within 72 hours
May be able to taper after 2-4 weeks but will require small dose for a year
Prednisolone management of giant cell arteritis
High dose
40-60mg/day orally
1mg/kg/daily or max 80mg/day
Continue 1 month then taper
Giant cell arteritis tx
High dose prednisone
AND
IL-6 receptor Tocilizumab subcu weekly
AND
Low-dose ASA for ischemia prevention
-For all pts with new or relapsing GCA
Giant cell arteritis
Inflammation of medium and large arteries
-granulomatous vasculitis
-giant cells disrupt elastic lamina
-leads to vessel wall thickening and ischemia
, Giant cell arteritis clinical presentation
Age over 50 years
Markedly elevated ESR and CRP
HA
Jaw claudication
Visual sx
Systemic sx (fever, fatigue, wt loss)
Limb claudication, possible aneurysm
Polymyalgia rheumatica in 40-60%
When giant cell arteritis is suspected
immediately initiate oral prednisone and STAT temporal artery biopsy or temporal artery
ultrasound
GCA PE
Tender/thickened temporal artery
Possible bruits, reduced pulses
When pt with giant cell arteritis seeks help for vision loss
IV pulse methylprednisolone (1g daily for 3 days) should be started but will likely not be
successful
Also STAT temporal artery bx
Giant cell arteritis gold standard for diagnosis
is temporal artery biopsy
2026 UPDATE | WITH COMPLETE SOLUTIONS
Polymyalgia rheumatica pathophys
IL-6 mediated inflammation of synovium and periarticular tissue
Polymyalgia rheumatica clinical presentation
Age over 50 years
Markedly elevated ESR and CRP
Pain and stiffness in shoulders and hips lasting for several weeks without other explanation
Polymyalgia rheumatica commonly occurs with
giant cell arteritis but not always
Polymyalgia rheumatica history
Profound stiffness and pain in shoulders, hip, low back
Fatigue
-trouble combing their hair, putting on a coat, or rising from a chair
Polymyalgia rheumatica is NOT
Muscle weakness (inflammation or nerve infarction)
Polymyalgia rheumatica PE
No muscle weakness
Decreased active ROM in shoulders/hips
,Low grade fever
Weight loss
Polymyalgia rheumatica initial diagnostics
ESR >30
CRP >0.5
Negative autoantibodies
US/MRI shows bursitis tenosynovitis
Polymalgia rheumatica differential dx
RA
Late-onset spondyloarthritis
Myopathies
Hypothyroidism
Malignancy or infx
Polymyalgia rheumatica management
Low dose prednisone
anti-IL-6Ra antibody, Sarilumab for refractory
Polymyalgia rheumatica drug classifications of all medications
corticosteroids
Sarilumab is a biologic DMARD, monoclonal antibody (anti-IL-6Ra antibody)
Prednisolone management of polymyalgia rheumatica
,Low dose
10-20mg/day orally
Should see dramatic improvement within 72 hours
May be able to taper after 2-4 weeks but will require small dose for a year
Prednisolone management of giant cell arteritis
High dose
40-60mg/day orally
1mg/kg/daily or max 80mg/day
Continue 1 month then taper
Giant cell arteritis tx
High dose prednisone
AND
IL-6 receptor Tocilizumab subcu weekly
AND
Low-dose ASA for ischemia prevention
-For all pts with new or relapsing GCA
Giant cell arteritis
Inflammation of medium and large arteries
-granulomatous vasculitis
-giant cells disrupt elastic lamina
-leads to vessel wall thickening and ischemia
, Giant cell arteritis clinical presentation
Age over 50 years
Markedly elevated ESR and CRP
HA
Jaw claudication
Visual sx
Systemic sx (fever, fatigue, wt loss)
Limb claudication, possible aneurysm
Polymyalgia rheumatica in 40-60%
When giant cell arteritis is suspected
immediately initiate oral prednisone and STAT temporal artery biopsy or temporal artery
ultrasound
GCA PE
Tender/thickened temporal artery
Possible bruits, reduced pulses
When pt with giant cell arteritis seeks help for vision loss
IV pulse methylprednisolone (1g daily for 3 days) should be started but will likely not be
successful
Also STAT temporal artery bx
Giant cell arteritis gold standard for diagnosis
is temporal artery biopsy
