Neurology&nbsp;&nbsp;&nbsp;

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

What is the stepwise investigation of patients suspected of inflammatory myopathy?

Especially in an inpatient setting when EMG is not immediately available.

5 Answers available

What are the current treatment options for progressive multifocal leukoencephalopathy in patients without HIV/AIDS?

Are there any clinical trials underway to study additional therapies?

Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?

7 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?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

What is your workup and treatment approach for cranial neuropathies in patients with lupus?

Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?

5 Answers available

How would you approach the workup and management of a young patient with recurrent biannual non-scarring oral ulcers and new onset neurologic symptoms with associated CNS white matter lesions concerning for Behcet’s?

How do you approach use of DMARDs and/or biologics for inflammatory arthritis in patients with a history of seizure disorder on anti-epileptic medications?

Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?

Do you send CSF or serum ACE levels in the workup of neurosarcoidosis?

If not, are there any serum or CSF tests you consider to be helpful?

What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

How do you workup patients with neuropathy suspected to be secondary to sarcoid?

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

Can you use leflunomide and rituximab in a patient with both multiple sclerosis and rheumatoid arthritis?

How do you approach management of patients with lupus and transverse myelitis not responding to pulse dose steroids?

How do you utilize cytokine panels in your clinical practice?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

What is your treatment approach to neurological Sjogrens disease with both peripheral neuropathy and transverse myelitis?

How will you sequence therapies in dermatomyositis given the results of the ProDERM trial?

Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...

Do you typically screen every patient with headaches after the age of 60 with ESR?

6 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?

How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?

Would a surgical decompression be indicated in a patient with amyloidosis and severe median neuropathy at the wrist?

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...

Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?

How should IVIG and either biologic injections or infusions be spaced?

Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?

Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?

Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?

How do you dose steroids in neurosarcoidosis patients with a worsening clinical symptoms or MRI findings?

Do you treat with only an IV steroid pulse or do you use an oral steroid taper as well? How long of a taper do you typically use?

If a patient with relapsing remitting MS has comorbid Sjogren's syndrome and is on hydroxychloroquine (Plaquenil), how does that impact choice of DMT for MS?

How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab unresponsive to standard therapies?

How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Ce...

Would you stop belimumab in a patient with SLE starting ravulizumab (C5 inhibitor) for myasthenia gravis due to concern for additive immunosuppression?

Which myositis patients are good candidates for IVIG?

In a patient with neurosarcoidosis who required infliximab for initially refractory symptoms but is now stable, how do you decide on the optimal time to de-escalate therapy?

How long can you treat dermatomyositis with IVIG?

Is there practical utility from obtaining CSF autoantibodies in patients with suspected neuropsychiatric systemic lupus erythematosus?

In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?

Also how would you manage this perioperatively?

7 Answers available

What is your workup for CSF studies when evaluating for possible CNS Lupus?

In addition, what formula do you use to calculate the IgG index?

Would you start anticoagulation in a patient with a history of CVA 1 year ago and high risk APL profile who was never started on anticoagulation, but is now presenting for follow up and without recurrent thrombotic events?

The patient has no known history of autoimmune disease.

What is your approach to elevated CK in patients without clinical or serologic evidence of immune mediated myopathy?

Is there any clinical benefit in referring patients with SLE or Sjogren's with cognitive impairment for neuropsychological testing?

How do you differentiate symptoms related to centralized pain syndrome from possible cognitive dysfunction?

What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?

Are there any instances where you would prefer a biosimilar rather than the reference product?

When tapering moderate to high doses of long term steroids do you routinely monitor for adrenal insufficiency?

Do you attempt to taper fully or maintain at a low dose?

How do you treat anti-HMGCoA myopathy?

Do you typically get muscle MRI in patients with symptoms of myopathy?

How do you manage a patient with progressive cerebellar ataxia and positive cardiolipin antibodies?

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

Do you typically see peripheral neuropathy in patients with castleman syndrome?

How do you manage a patient with giant cell arteritis treated with weekly tocilizumab and low dose glucocorticoid who develops sudden vision loss?

Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers 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?

How would you approach the treatment of erosive inflammatory arthritis (RA or SpA) in a patient with multiple sclerosis on ocrelizumab who has failed csDMARD therapy?

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

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?

When do you consider immunosuppression in patients with Sjogren's neuropathy?

How do you approach the workup of a patient with incidentally found pachymeningitis?

Why do we not typically see features of rhabdomyolysis or acute kidney injury with idiopathic inflammatory myopathies?

How do you approach the workup for patients with hyperCKemia and positive NXP2 with no clinical symptoms?

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

How do you decide on initiation of treatment with steroids or immunomodulatory therapy in patients with statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy?

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis and long-term monitoring/treatment?

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?

What workup do you do for patients who have PL-7 elevation when screening for myopathy?

How do you work up patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance?

For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...

How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

At what point do you recommend muscle biopsy in the workup for myositis?

In what patients would you consider adjunctive IVIG for Sjogren's-related neuropathy?

Can giant cell arteritis present with a partial cranial neuropathy?

When would you suspect metabolic myopathy and what is your approach to initial workup?

What is the role of x-ray of the cervical or lumbar spine in patients presenting with radicular symptoms?

I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...

How do you treat lupus-associated small fiber neuropathy?

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

Do you recommend EMG/NCS in all patients with clinical findings of carpal tunnel syndrome?

At what point is a skin biopsy indicated in patients with neuropathy?

Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?

Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

How do you treat post-IVIG headache that is not responsive to Tylenol or NSAIDs?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

What is the utility in repeating a temporal ultrasound (US) in a previously US diagnosed positive GCA patient who has received treatment and is presenting with recurrent GCA symptoms?

How do you manage a patient with inclusion body myositis?

Is there a role for immunomodulatory therapy?

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

What suspected myositis manifestations drive you to start empiric therapy before the work-up is complete?

Myositis specific antibodies and pathology results often take weeks to result. In which cases do you start therapy before the diagnosis is solid...

What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

What is your approach to checking serum vWF antigen levels in adult patients with CNS vasculitis for monitoring disease activity?

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

What is your approach for treating mononeuritis multiplex in patients with ANCA vasculitis?

Specifically, do you reach for Rituximab or cyclophosphamide?

Would you consider using a TNFi in a patient with a family history of demyelinating disease, in the absence of a personal history?

How do you approach the use of biologics in patients with a history of Guillain-Barre syndrome?

Are there features of a nerve biopsy that help distinguish late nerve damage from vasculitis versus from a demyelinating disease?

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

How do you monitor response to treatment in patients with mononeuritis multiplex secondary to vasculitis?

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...

Is it safe to use statins in IIM patients if HMGCR antibodies are negative?

Do you recommend getting a muscle biopsy in a patient with suspected IMNM with statin exposure, weakness, elevated CK, and positive HMGCR antibody?

What steroid-sparing agent would you use for treatment of neurosarcoidosis with leptomeningeal and parenchymal involvement?