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Prep smart and pass with confidence. IHCA's Licensure Review Course
November 17-18, 2026
https://t.co/SI7tyJV59V
#licensurereviewcourse #administratorsexam #nursinghomeadministrator #LRC #reviewcourse
#ReviewCourse PMR steroid-sparing trials MTX, IL-6 inhibitors and secukinumab have demonstrated efficacy in randomized trials.
GC-free remission: MTX 80 vs 46%, TCZ 58 vs 18%, RTX 52 vs 21%.
Sustained remission: SAR 28 vs 10%, SEC 41 vs 20%.
Olokizumab: response 68 vs 21%.#ACR26
#ReviewCourse Early MTX in PMR: emerging evidence ➡️ The PMR-MODE trial (n=58) showed higher GC-free remission at 52 weeks with MTX 25 mg/week vs placebo (80% vs 46%), without a significant ⬇️ in cumulative GC exposure. Promising findings, but limited by sample size. #ACR26
#ReviewCourse PMR ➡️ EULAR 2025 recommends prednisone 15–25 mg/day, aiming for withdrawal within 1 year. Yet a meta-analysis found ongoing glucocorticoid use in 77%, 51%, and 25% at 1, 2, and 5 years. This highlights a substantial unmet need. #ACR26
#ReviewCourse Imaging in polymyalgia rheumatica ➡️ Use imaging according to clinical probability: it is unnecessary to confirm typical PMR or rule it out when suspicion is low. It adds the most value in atypical presentations, discordant findings, and potential mimics. #ACR26
#ReviewCourse Imaging supports, not confirms PMR. Subclinical GCA: 9–23%, unclear impact. Aortic risk rises in GCA, not isolated PMR. #ACR2026
#ReviewCourse GIOP ➡️ Assess fracture risk beyond BMD. Consider anabolics at very high risk; use a bisphosphonate when stopping denosumab. #ACR26
#ReviewCourse Glucocorticoid-Induced-Osteoporosis ➡️ Fracture risk rises even at low doses.
Bone loss peaks early: assess promptly and adjust FRAX for GC dose. #ACR26
#ReviewCourse Menopause & SARDs: Pain and fatigue: menopause or flare? Check for synovitis. For hot flashes, assess MHT risks; avoid in APS/aPL+. #ACR26
#ReviewCourse EULAR recommendations: TNFi throughout pregnancy if needed; other biologics case by case. All compatible with breastfeeding.
Vaccines 💉 Inactivated vaccines on schedule; rotavirus after TNFi. Following late RTX/belimumab, await B-cell recovery. #ACR26
#ReviewCourse ACR: Drugs & Pregnancy ➡️ Avoid MTX, leflunomide and mycophenolate. HCQ, sulfasalazine, colchicine and AZA: compatible in pregnancy/lactation.
👁️ AZA Compatible with pregnancy, but linked to cholestasis. Check bile acids if itching; stop if confirmed. #ACR26
#ReviewCourse aPL without APS: consider aspirin. Obstetric APS: aspirin + prophylactic LMWH; thrombotic APS: aspirin + therapeutic LMWH.
IMPACT study in APS: Certolizumab + aspirin/LMWH: 20% adverse outcomes vs 44% historical controls. Nonrandomized phase II. #ACR26
#ReviewCourse Pregnancy & antiRo+ ➡️ Fetal AV block risk: 1–3%, higher after affected child. Early HCQ may lower recurrence; fetal echo at 16–26 weeks. #ACR26
#ReviewCourse Pregnancy in SLE increases flare and obstetric risks, particularly with nephritis.
Continue HCQ; add low-dose aspirin.
Pregnancy raises C3/C4 and ESR.
Normal complement doesn’t exclude lupus activity; check labs each trimester. #ACR26
#ReviewCourse Higher obstetric risk in people with SARDs: plan after 3–6 months of control on safe therapy. In SLE, continue HCQ; consider aspirin. #ACR26
#ReviewCourse While genetics is usually complex, early or familial onset suggests monogenic disease. A negative panel does not rule it out. #ACR26
#ReviewCourse Somatic UBA1 mutations cause VEXAS; pathogenic NLRC4 variants can also drive autoinflammation. #ACR26
#ReviewCourse SLE risk involves common and rare variants, including TLR7.
Polygenic risk scores perform less well across non-European ancestries.
APOL1 risk variants are linked to lupus nephritis, greater organ damage and mortality. #ACR26
#ReviewCourse GWAS highlight the role of HLA-DRB1 and the shared epitope in RA susceptibility. Yet genetic associations do not necessarily establish causality or bring us closer to a cure. #ACR26
#ReviewCourse ICI-related sicca is managed mainly with supportive care, while ICI-induced myositis may require aggressive immunosuppression, including high-dose steroids and IVIG. Abatacept and JAK inhibitors are emerging options for selected severe cases. #ACR26
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