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Polymyalgia Rheumatica

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Prednisone
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Prednisone 5mg/10mg/20mg Tablet
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Methylprednisolone
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Methotrexate 10mg-25mg auto-injector
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Methotrexate 2.5mg Tablets
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Methotrexate 2mg/ml PO
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Methotrexate Tablet
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Methotrexate 7.5mg - 30mg Auto-Inector
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Ustekinumab
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Anakinra
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acetaminophen
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Ibuprofen
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ibuprophen
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Sarilumab
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Tocilizumab
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Sumatriptan
Anisha Dua, MD, MPH Northwestern University Feinberg School of Medicine

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PMR & GCA - Case 1

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PMR & GCA - Case 2

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Polymyalgia Rheumatica (PMR) - Basic Level

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Polymyalgia Rheumatica with Suspected Giant Cell Arteritis (GCA)- Intermediate Level

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Refractory Giant Cell Arteritis (GCA) - Advanced Level

1. Which of the following clinical features is most indicative of Giant Cell Arteritis (GCA) rather than Polymyalgia Rheumatica (PMR)?

Select only 1 answer.

  1. A. Shoulder girdle pain
  2. B. Elevated ESR
  3. C. Jaw claudication
  4. D. Rapid response to low-dose prednisone

2. Which laboratory finding is essential for diagnosing Polymyalgia Rheumatica (PMR)?

Select only 1 answer.

  1. A. Elevated C-reactive protein (CRP)
  2. B. Positive Anti-CCP antibodies
  3. C. Low hemoglobin
  4. D. Elevated serum creatinine

3. Which imaging modality is recommended to evaluate cranial artery involvement in suspected Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. Ultrasound
  2. B. X-ray
  3. C. MRI
  4. D. CT scan

4. What is the recommended initial dose of prednisone for suspected Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. 10 mg daily
  2. B. 25 mg daily
  3. C. 40 mg daily
  4. D. 1 mg/kg daily

5. Which cytokine is targeted by tocilizumab in the treatment of Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. TNF-alpha
  2. B. IL-1
  3. C. IL-6
  4. D. IL-12/23

6. In patients with suspected Giant Cell Arteritis (GCA), which diagnostic test should be performed promptly to confirm the diagnosis?

Select only 1 answer.

  1. A. Rheumatoid factor test
  2. B. Temporal artery biopsy
  3. C. MRI of the brain
  4. D. Chest X-ray

7. Which of the following is a significant limitation of temporal artery biopsy as a diagnostic tool for Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. It is unable to detect extracranial large vessel involvement
  2. B. It has a high rate of false positives
  3. C. It may miss inflammation if a large-enough piece of artery is not sampled
  4. D. A&C

8. What is the significance of a normal ESR in a patient with clinical features suggestive of Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. It excludes the diagnosis of GCA
  2. B. It suggests an early stage of GCA
  3. C. It indicates the need for alternative diagnosis
  4. D. It is irrelevant to the diagnosis

9. A 72-year-old woman presents with bilateral shoulder pain, hip stiffness, and an elevated ESR. She has no visual symptoms or jaw claudication. Her clinician suspects Polymyalgia Rheumatica (PMR). Which of the following additional findings would most strongly support a diagnosis of PMR rather than Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. Rapid improvement of symptoms with low-dose prednisone (10-20 mg/day)
  2. B. Presence of a temporal artery bruit on physical examination
  3. C. Elevated C-reactive protein (CRP) levels
  4. D. Normocytic anemia on complete blood count (CBC)

10. Which is the most appropriate management for a patient with Giant Cell Arteritis (GCA) who has developed vision loss?

Select only 1 answer.

  1. A. Methotrexate
  2. B. High-dose intravenous methylprednisolone
  3. C. Low-dose oral prednisone
  4. D. NSAIDs

11. What is the role of interleukin-6 (IL-6) in the pathogenesis of Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. It is only elevated in PMR
  2. B. It mediates inflammatory response in both conditions
  3. C. It is inhibited by methotrexate
  4. D. It is not involved in either condition

12. In the management of Polymyalgia Rheumatica (PMR), if a patient experiences recurrent symptoms despite gradual tapering of low-dose prednisone, which of the following is the most appropriate long-term strategy?

Select only 1 answer.

  1. A. Increase the prednisone dose back to the initial level
  2. B. Add methotrexate as a steroid-sparing agent
  3. C. Perform a temporal artery biopsy to rule out Giant Cell Arteritis (GCA)
  4. D. Switch to high-dose corticosteroids

13. Which of the following is a potential complication of untreated Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. Osteoporosis
  2. B. Vision loss
  3. C. Diabetes mellitus
  4. D. Hypertension

14. What percentage of patients with Polymyalgia Rheumatica (PMR) will develop Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. 5%
  2. B. 15%
  3. C. 25%
  4. D. 50%

15. What is the primary reason for monitoring inflammatory markers in patients with Giant Cell Arteritis (GCA)?

Select only 1 answer.

  1. A. To diagnose rheumatoid arthritis
  2. B. To assess response to therapy and detect relapses
  3. C. To monitor liver function
  4. D. To evaluate kidney function