Gastroenterology

Rheumatology

Questions discussed in this category

How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?

The patient was diagnosed on the basis of ANA 1:1,280, strongly positive Smith, Sm-RNP, dsDNA, pericarditis, inflammatory arthritis, and discoid lupus...

3 Answers available

How do you approach managing nausea and GI side effects when initiating methotrexate?

3 Answers available

How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?

2 Answers available

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

7 Answers available

How would you approach management of a patient with a medium-to-large vessel vasculitis who developed perforation of the stomach and colon on steroids and cyclophosphamide?

Vasculitis involving aorta, subclavian, common carotid, SMA, IMA, renal artery, and celiac artery.

1 Answer available

Do you feel comfortable using Jak inhibitors in patients with a strong family history of CAD, but no other risk factors?

How do you counsel patients in this scenario?

1 Answer available

What treatments have you found most effective for cholestatic pruritus?

I have a patient with recently diagnosed primary biliary cholangitis/cirrhosis (PBC) with SSc. Her laboratory values are within normal limits, but end...

1 Answer available

Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?

3 Answers available

Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?

1 Answer available

Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?

1 Answer available

How do you monitor patients with incidentally found high titer anti-smooth muscle antibodies without stigmata of liver disease?

3 Answers available

How would you manage a patient with highly active ankylosing spondylitis, iritis and Crohn’s, controlled with weekly adalimumab with co-morbid IgG4RD and intolerance of azathioprine due to elevated LFTs?

IgG4 manifestations include autoimmune pancreatitis and periaortic soft tissue mass.

2 Answers available

What is your approach to working up diarrhea in an immunocompromised patient?

1 Answer available

Do you have concerns with the use of oral contraceptives in patients on JAK inhibitors given the black box warning for thromboembolic events?

How has this impacted your counseling and management?

2 Answers available

How would you manage autoimmune pancreatitis in a patient after Whipple's procedure?

1 Answer available

How do you approach an obese patient on long-term methotrexate with normal liver tests in terms of workup for underlying fatty liver?

Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?

1 Answer available

How do you approach GI prophylaxis (e.g., PPIs, H2 blockers) in patients on long-term NSAIDs?

1 Answer available

Do you consider anti-viral prophylaxis in patients taking JAK inhibitors who have recurrent uncomplicated Zoster infection, but would prefer not changing therapy?

2 Answers available

Does hepatitis B vaccination reduce the risk of HBV reactivation associated with immunosuppressive therapy?

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

2 Answers available

How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

1 Answer available

Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?

1 Answer available

Do you stop TNF inhibitors during the third trimester of pregnancy?

2 Answers available

Which biologics are you comfortable combining with vedolizumab for spondyloarthritis or psoriatic arthritis patients in the setting of well-controlled inflammatory bowel disease?

2 Answers available

What is your approach to continuing or altering therapy when inheriting a patient with combined biologic immunosuppression that is in excess of guidelines?

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

1 Answer available

How do you manage calcium and vitamin D replacement in scleroderma and myositis patients with dysphagia and malabsorption?

1 Answer available

What is your approach to management of elevated liver enzymes in patients who recently started treatment with tocilizumab?

1 Answer available

Would you consider rituximab in a patient with severe GI dysmotility caused by scleroderma?

2 Answers available

What is your approach to pharmacologic treatment options in a patient with both SLE and Crohn's disease?

A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...

1 Answer available

How do you approach management of patients with active RA and recurrent non-severe C.diff?

(Patient with active RA despite hydroxychloroquine)

1 Answer available

Would you be comfortable using a JAK inhibitor in a patient with baseline thrombocytosis?

Would the etiology of the thrombocytosis play a role in your decision-making?

1 Answer available

How do you counsel patients about the malignancy risk associated with azathioprine?

1 Answer available

Do you discontinue or adjust azathioprine when a patient develops elevated MCV after starting it?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

2 Answers available