General Rheumatology

Questions discussed in this category

How do you approach CV risk assessment in RA patients when RA itself is associated with some degree of increased CV risk at baseline?

Recent articles regarding the use of JAK-Inhibition in RA have suggested to avoid in patients with increased CV risk. However, RA itself is cons...

2 Answers available

Do you use conventional DMARDs aside from methotrexate to prevent anti-drug antibody development for patients on infliximab?

1 Answer available

What is the role of non-prednisone oral glucocorticoids in the management of systemic rheumatologic disease?

Such as oral methylprednisolone, dexamethasone, prednisolone, etc.

1 Answer available

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

1 Answer available

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

1 Answer available

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

2 Answers available

What is the difference between Multisystem Inflammatory Syndrome in Adults (MIS-A) and MAS/HLH?

1 Answer available

Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?

1 Answer available

When would you consider rituximab as induction therapy in IgG4-related disease?

2 Answers available

Do you treat fibromyalgia in your practice or do you refer back to PCP after ruling out autoimmune inflammatory pathology?

3 Answers available

How do you utilize methotrexate and/or hydroxychloroquine in the setting of limited scleroderma/CREST?

1 Answer 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

What is your approach to the workup for an underlying systemic condition in a patient presenting with retinal vasculitis?

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

Are there any known contraindications for IL-23 use in patients with psoriatic arthritis and CKD or ESRD?

1 Answer available

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?

2 Answers 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

What is your approach to evaluation of underlying autoimmune disease in patients with bilateral scleromalacia?

1 Answer available

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 ...

4 Answers available

How do you treat celiac disease associated inflammatory arthritis refractory to gluten free diet?

1 Answer available

Is there a role for prednisolone over prednisone in rheumatic patients with hepatic impairment?

1 Answer available

When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?

How do you decide if it may be safe to continue immunotherapy?

1 Answer available

Given the "LDL Paradox", in which RA patients with the highest levels of inflammation can have ultra-low levels of LDL (<70), how do you approach initiation of statin therapy in these patients?

Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...

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 will you use REGEN-COV (casirivimab/imdevimab-monoclonal antibody treatment recently approved under EUA as post-exposure prophylaxis for Covid) in rheumatic patients on immunosuppressive therapy?

Would you consider this for patients on B-cell depleting therapies or more broadly for other immunosuppressive agents?

2 Answers available

What is your management approach for patients with Adult Onset Still's who are planning pregnancy?

1 Answer available

What are your recommendations regarding methotrexate usage in patients with persistent chest CT changes post COVID pneumonia?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

2 Answers available

How do you diagnose and treat patients who develop uveitis while on bisphosphonate therapy for osteoporosis?

Are there specific features that suggest drug-induced uveitis versus de novo uveitis?

1 Answer available

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

1 Answer available

What is your differential for a patient presenting with multiple digits affected by flexor tenosynovitis, dupuytren's, and no evidence of peripheral inflammatory arthritis?

1 Answer available

How do you approach folate supplementation for methotrexate-related side effects?

3 Answers available

What is your approach to monitoring lipids in patients with rheumatic diseases such as RA and SLE and do you have a lower threshold to start lipid lowering agents compared to the general population?

2 Answers available

Are there any specific circumstances when you would consider the use of immunosuppression for DISH?

There is some emerging evidence that there is an inflammatory component.

1 Answer available

How would you counsel a patient who is interested in using supplements (such as fish oil or turmeric) as an adjunct to treatment of inflammatory arthritis?

3 Answers available

How do you approach the treatment of eosinophilic fasciitis refractory to glucocorticoids and methotrexate?

1 Answer available

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

2 Answers available

How do you approach management of patients with inflammatory arthritis who are asymptomatic but develop radiographic progression?

1 Answer available

What is your threshold for number of alcoholic drinks per week before reconsidering prescribing methotrexate/leflunomide?

1 Answer available

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

1 Answer available

What is your approach to managing abnormal lipids in a patient on tocilizumab?

1 Answer available

How do you approach the treatment of inflammatory polyarthritis in patients with myelodysplastic syndromes?

2 Answers available

How do you approach the evaluation of patients referred for chronic lyme disease and counsel patients regarding this entity?

1 Answer available

Do you extrapolate from uveitis treatment pathways when managing other inflammatory eye conditions such as atypical serpiginous choroiditis?

2 Answers available

Do you switch to certolizumab in RA patients who are doing well on other TNFis and planning to become pregnant?

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

Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?

1 Answer available

Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?

2 Answers available

How do you approach patients with overlapping features of PMR and seronegative RA?

1 Answer available

How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?

2 Answers available

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

1 Answer available

How do you interpret a high positive RNP in the setting of a negative ANA and negative sm/RNP?

To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)

1 Answer available

Is there an increased risk of COVID-19 in patients on immunosuppressants?

1 Answer available

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

1 Answer available

What is your inflammatory arthritis differential when a patient presents with unilateral TMJ synovitis?

2 Answers available

What are examples of rheumatology quality measures that are both clinically meaningful and can be captured accurately and efficiently?

1 Answer available

Which steroid-sparing agent do you prefer to treat multi-organ Sweet's syndrome?

1 Answer available

Do you follow patients with elevated ESR/CRP if their work-up for rheumatologic etiology is unrevealing and no other cause is identified?

2 Answers available

What would be your differential for a wrist monoarthritis in an elderly female with erosions on MRI after less than 3 months of symptoms?

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

Is there a role for tocilizumab in treatment of polymyalgia rheumatica in patients who do not have features of giant cell arteritis or rheumatoid arthritis?

1 Answer available

Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?

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 and rheumatism, 1982-11

The 1982 revised criteria for the classification of systemic lupus erythematosus.

Arthritis and rheumatism, 2012-08

Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.

, 2019 Aug 06

2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus.

Arthritis Rheum.,

Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

,

Brief Report: A Prospective Open-Label Phase IIa Trial of Tocilizumab in the Treatment of Polymyalgia Rheumatica.

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.

Eur J Rheumatol, 2017 Feb 23

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures.

Rev Bras Reumatol Engl Ed, 2016 Mar 16

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

Southern medical journal, 2016-11

Effects of Statin Therapy in Patients with Systemic Lupus Erythematosus.

Annals of the rheumatic diseases, 2011-05

Lupus Atherosclerosis Prevention Study (LAPS).

Atherosclerosis, 2015 Aug 28

Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study.

N Engl J Med, 2020 Apr 29

Covid-19 in Immune-Mediated Inflammatory Diseases - Case Series from New York.

JAMA network open, 2018-11-02

Association of Immunoglobulin Levels, Infectious Risk, and Mortality With Rituximab and Hypogammaglobulinemia.

The Journal of arthroplasty, 2008-02

Determining "true" leukocytosis in bloody joint aspiration.

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.

Clin Infect Dis,

Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease.

Cochrane Database Syst Rev, 2013 May 31

Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.

Ann Rheum Dis, 2017 Mar 23

Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate.

Clin Pharmacokinet,

Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids.

Gut,

Impaired conversion of prednisone to prednisolone in patients with liver cirrhosis.

Arthritis and rheumatism, 2001-12

Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides.

J Med Food,

Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Int J Clin Pract, 2021 Apr 29

Curcumin and rheumatoid arthritis: A systematic review of literature.

Nutrients, 2020 Dec 11

Efficacy of Spice Supplementation in Rheumatoid Arthritis: A Systematic Literature Review.

Current rheumatology reports, 2009-10

Diffuse idiopathic skeletal hyperostosis: differentiation from ankylosing spondylitis.

Radiology,

Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH).

Curr Rheumatol Rep, 2021 Jan 26

Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component.

N Engl J Med, 2021 Aug 04

Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19.

Curr Opin Rheumatol,

Retinal vasculitis.

BMJ Open, 2019 May 05

Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts.

Rheumatol Int, 2021 Jan 29

Does methotrexate cause progressive fibrotic interstitial lung disease? A systematic review.

Rheumatology (Oxford),

Five successful pregnancies with antenatal anakinra exposure.

Z Rheumatol,

[IL-1-blockade with Anakinra during pregnancy : Retrospective analysis of efficacy and safety in female patients with familial Mediterranean fever].

Journal of neurovirology, 2018-06

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

Curr Med Chem,

Targeting IL-17 and IL-23 in Immune Mediated Renal Disease.

Pathology, 2017 Mar 11

The role of interleukin-17A in the pathogenesis of kidney diseases.

The Lancet. Respiratory medicine, 2016-09

Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial.

Neth J Med,

The treatment outcomes in IgG4-related disease.

Medicine (Baltimore),

Therapeutic approach to IgG4-related disease: A systematic review.

Ann Rheum Dis, 2016 Oct 03

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

ACR Open Rheumatol, 2021 Aug 25

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children.

Arthritis Res Ther, 2021 Mar 22

Vision loss in patients with giant cell arteritis treated with tocilizumab.

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