Rheumatology

Infectious Disease

Questions discussed in this category

How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?

1 Answer available

What approaches can we take to initiate therapy and improve survival rates in patients with HLH?

1 Answer 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

How would you approach immunomodulatory treatment for systemic lupus associated protein losing enteropathy (PLE) in a patient whose clinical course has been complicated by significant infection?

Additionally, is it correct to assume that IV therapies might be preferred vs oral treatment given alterations in GI absorption in PLE?

1 Answer available

How would you approach the use of JAK inhibitors in a patient with stable RA who is now starting treatment for pulmonary MAC infection?

Patient previously failed abatacept and Rituximab.

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

How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?

Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR

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 long would you treat with antimycobacterials before starting biologic DMARD in a patient with latent TB and active rheumatoid arthritis?

1 Answer available

How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?

1 Answer available

Do you treat HIV/AIDS-associated CNS vasculitis with antiretrovirals alone or in combination with steroids?

1 Answer available

How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as anti-TNF alpha therapy?

For example, healthcare workers who require these vaccines for employment

1 Answer available

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

1 Answer available

Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?

1 Answer available

How would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?

Do you stop methotrexate or adjust the dose?

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

Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?

1 Answer available

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

1 Answer available

How would you attempt to determine the etiology of intracranial hemorrhage in a patient with newly diagnosed lupus and an active viral infection?

1 Answer available

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

1 Answer available

Should tuberculosis screening be performed before beginning methotrexate for treatment of rheumatoid arthritis?

1 Answer available

In what situations do you check for HIV status in your workup for inflammatory arthritis?

1 Answer available

What is your approach to dental prophylaxis for patients on biologics?

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, 2012-05

2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in 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.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2008-10

Prophylactic antibiotic usage for Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologists and the review of literature.

Clin Rheumatol, 2006 Dec 21

Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review.

Rheumatol Int, 2020 Sep 18

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study.

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.

Ann Rheum Dis, 2019 Aug 14

2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.

Arthritis Rheum,

Tuberculosis associated with therapy against tumor necrosis factor alpha.

Journal of neurovirology, 2018-06

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

Arthritis Care Res (Hoboken), 2021 Jul

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Clin Liver Dis (Hoboken), 2018 Aug 22

Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance.

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.

Medicine, 2014 Oct

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

Arthritis and rheumatism, 2013-07

Vitamin D in systemic lupus erythematosus: modest association with disease activity and the urine protein-to-creatinine ratio.

Rheumatology international, 2011 Feb 23

Lupus protein-losing enteropathy (LUPLE): a systematic review.

Arthritis & rheumatology (Hoboken, N.J.), 2023 Jun 01

Comparative Risks of Infection With Belimumab Versus Oral Immunosuppressants in Patients With Nonrenal Systemic Lupus Erythematosus.

Arthritis care & research, 2016 Jan

Vitamin D Supplementation in Adolescents and Young Adults With Juvenile Systemic Lupus Erythematosus for Improvement in Disease Activity and Fatigue Scores: A Randomized, Double-Blind, Placebo-Controlled Trial.

Lupus, 2014 Feb 06

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

Current opinion in rheumatology, 2018 Jul

Trimethoprim-sulfamethoxazole and antineutrophil cytoplasmic antibodies-associated vasculitis.

European journal of medical research, 2009 Dec 07

Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement.

Annals of the rheumatic diseases, 2018 Jun 27

Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis.

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