Infectious Disease

General Rheumatology

Questions discussed in this category

For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?

6 Answers available

What isolation policies are Rheumatology offices employing for both staff and patients diagnosed with COVID-19 given the new CDC guidelines?

CDC Healthcare Guidance CDC Isolation and Work Restriction Guidance CDC Immunocompromised Guidance

1 Answer available

How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?

5 Answers available

How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?

How do you approach ongoing screening for TB in patients with history of treated latent TB, but have ongoing use of DMARDs and/or biologics given quan...

1 Answer available

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

1 Answer available

Do you typically adjust or hold immunosuppression in a well-controlled RA patient who is being treated for Mycobacterium avium-intracellulare (MAI)?

1 Answer available

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

2 Answers available

Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?

2 Answers available

In a patient who is on oral DMARDs and has received 3 COVID boosters, but recently had COVID-19 infection, is bivalent booster still recommended 3 months later?

4 Answers available

How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?

3 Answers 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

How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?

Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?

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

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

3 Answers available

In patients taking biologics who are planning joint replacement and are known MRSA carriers do you perform decolonization prior to surgery?

1 Answer available

What is the optimal timing for Zoster vaccine administration for a patient who recently recovered from herpes zoster infection and is now planning to start B-cell depletion therapy?

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

How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?

4 Answers available

How do you approach treatment of RA with methotrexate in a patient with treated Hepatitis C and normal liver function?

1 Answer available

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

3 Answers available

Which medications have the lowest risk of tuberculosis reactivation in patients with uncertain tuberculosis history and active rheumatologic disease?

2 Answers available

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

1 Answer available

Is there a role for regular hepatitis and TB screening in patients on chronic immunosuppressive therapy in the absence of new risk factors or exposures?

1 Answer available

How do you think about biologic use in patients with underlying HIV infection?

2 Answers available

Do you hold tocilizumab for patients who are diagnosed with Covid and are with mild to moderate symptoms or non-hospitalized?

1 Answer available

Is there a role for antibody testing to confirm vaccine response for patients on rituximab after COVID-19 vaccination?

1 Answer available

When would you consider checking JC virus prior to initiating biologic therapy?

1 Answer available

How are you timing the third dose of the COVID-19 mRNA vaccine in patients on rituximab?

1 Answer available

How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?

1 Answer available

Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?

5 Answers available

Would you hold all immunosuppressive medications for the first month of LTBI treatment, or just biologics?

1 Answer available

Do you avoid any specific biologic therapies in HIV positive patients?

1 Answer available

How do you manage patients who are Hepatitis B core antibody positive/surface antigen negative and starting a biologic DMARD (other than rituximab)?

1 Answer available

Papers discussed in this category

Arthritis Rheumatol, 2016 Jan

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Arthritis care & research, 2017-03

Rates of Serious Infections in HIV-Infected Patients Receiving Tumor Necrosis Factor Inhibitor Therapy for Concomitant Autoimmune Diseases.

Clin Exp Dermatol, 2018 May 24

Treatment of psoriasis with ustekinumab in a patient with HIV-related Kaposi sarcoma.

N Engl J Med,

Clinical practice. Care of the asplenic patient.

Mediterr J Rheumatol, 2020 Jun 11

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies.

Journal of neurovirology, 2018-06

Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event.

Scientific reports, 2017 Aug 10

Analysis of Factors Influencing Diagnostic Accuracy of T-SPOT.TB for Active Tuberculosis in Clinical Practice.

Clin Microbiol Infect, 2018 Feb 07

ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Introduction).

PET Clin, 2020 Feb 11

18F-Fluorodeoxyglucose PET/Computed Tomography in the Diagnosis and Monitoring of Giant Cell Arteritis.

Rheumatology (Oxford), 2022 Jul 22

PET/CT of cranial arteries for a sensitive diagnosis of giant cell arteritis.

Arthritis & rheumatology (Hoboken, N.J.), 2017-10

The Safety and Immunogenicity of Live Zoster Vaccination in Patients With Rheumatoid Arthritis Before Starting Tofacitinib: A Randomized Phase II Trial.

Arthritis Care Res (Hoboken), 2016 Jan

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Alimentary pharmacology & therapeutics, 2022 May 20

Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management.

Medicine, 2014 Oct

Intravenous immunoglobulin in the therapeutic armamentarium of systemic lupus erythematosus: a systematic review and meta-analysis.

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