Questions discussed in this category
Does the recommendation change based on the DMARD?
No active joint disease, patient on Hydroxychloroquine and Cimzia. Normal ESR/CRP.
Are there specific immunosuppressive agents effective for this manifestation?
Are there any clinical trials underway to study additional therapies?
SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...
For example, is captopril dialyzable?
What do adult rheumatologists need to understand about pediatric diseases?
Synovial fluid analysis: cell count >100,000, > 80% neutrophils. Gram stain, cultures (including fungal and mycobacterial), synovial biopsy, and...
Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?
UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...
The patient was treated with two doses of Rituximab and on MMF. Now with stable lung function and normalized CK.
Can nodular scleritis be a presenting manifestation of GCA?
What imaging do you use to monitor disease activity?
Imaging only shows chronic, fibrotic lesions making it hard to assess disease activity.
What nuances do adult rheumatologists need to understand about pediatric diseases?
Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?
Which csDMARD do you taper in order, and is there a tapering strategy (duration/dose)?
Given the drug-drug interaction, do you monitor more closely for methotrexate toxicity, counsel on symptoms of methotrexate toxicity, or avoid the com...
E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.
Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.
Is the diagnosis of Sjogren's mostly clinical in a patient with a consistent history and physical with positive serologies?
Normal Vitamin D, bone scan showed osteoarthritis
The patient has no extraocular features of a spondyloarthropathy and is on methotrexate. No active eye disease for past 1 year.
Pt with active skin and joint disease. Previously on Cemiplimab (PD-1) for squamous cell carcinoma of the skin. Do you avoid traditional DMARDs due to...
In which situations or patient populations do you find this useful? How is it sterilized?
Does your choice of DMARD/biologics change due to increased risk of malignancy?
Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...
Heritable autoinflammatory gene testing negative.
Is there a role for TNF inhibitor?
Would it be safe to resume and if so, when?
Thrombocytopenia is moderate (80-100,000 microL). No concomitant cytopenias present.
Do you frequently order liver biopsies for these patients?This question is part of a collaboration with RheumMadness and is specifically in reference ...
CDC Healthcare Guidance
CDC Isolation and Work Restriction Guidance
CDC Immunocompromised Guidance
This question is part of a collaboration with RheumMadness and is specifically in reference to: Prevention of Autoimmune Disease: Vitamin D and O...
Do you plan to use sarilumab for all patients with relapsing or refractory PMR or are there certain features that will make you more or less likely to...
Would you obtain renal biopsy first or treat with additional immunosuppression for suspected renal involvement related to IgG4?
What formulation of topical nitroglycerin do you use?
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...
How has this impacted your counseling and management?
If so, do you routinely recommend use of an additional form of contraception?
How much cumulative prednisone exposure do you tolerate and how many attempts at tapering will you pursue before considering addition of a steroid spa...
This question is part of a collaboration with RheumMadness and is specifically in reference to: Antibodies Before SLE.
Would you consider alternative B cell depleting therapies such as ofatumumab or ocrelizumab?
For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?
Would you consider belimumab over a TNF inhibitor for inflammatory arthritis? Which agent would be more beneficial for the lung disease?
Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?
How should IVIG and either biologic injections or infusions be spaced?
After what interval of sustained remission will you attempt to taper, and will you do so by first widening the dosing interval?
Will you initiate sarilumab as a first steroid sparing agent or will you still pursue a DMARD such as methotrexate before initiating sarilumab? To wha...
Do you universally perform baseline DEXA and Hgb A1C? How often are you obtaining routine labs?
Patient has received treatment with Rituximab and is taking hydroxychloroquine.
For example, patients who have been maintained on 5mg of prednisone for years without previous tapering attempts and the rheumatic disease is not acti...
If so, when do you recommend timing for the cataract surgery?
And if so, what is your approach to the diagnosis?
Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.
Patient is on antibiotics for chronic spinal hardware infection.
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...
The patient is on a dose of 22 mg of methotrexate weekly for severe rheumatoid arthritis.
If you would discontinue the methotrexate, how long would y...
Patient with nephrotic range proteinuria, but there is no evidence of active TMA on renal biopsy.
Patient with dermatomyositis on rituximab with refractory inflammatory arthritis. Intolerant of traditional DMARDs such as methotrexate, leflunomide, ...
It's been 5+ years after the first course. If you decide to re-irradiate what dosing schema would you use?
This question is part of a collaboration with RheumMadness and is specifically in reference to: Etanercept + Methotrexate.
Apart from ruling out malignancy or infection?
How do you differentiate symptoms related to centralized pain syndrome from possible cognitive dysfunction?
Such as Leflunomide, Sulfasalazine, Mycophenolate or Azathioprine, since all of these medications have potential to cause liver enzyme elevation and i...
(Patient with active RA despite hydroxychloroquine)
In what cases do you discontinue the medication?
Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedan...
Are there any instances where you would prefer a biosimilar rather than the reference product?
Patient with sacroiliitis on imaging, failure of two NSAIDs.
Do you attempt to taper fully or maintain at a low dose?
Would the etiology of the thrombocytosis play a role in your decision-making?
This question is part of a collaboration with RheumMadness and is specifically in reference to:BeSt TrialMeasurement of Patient Outcomes in Arthritis
In a patient for whom rituximab is the best option for their disease management.
Patient failed topical ocular therapies, methotrexate, azathioprine.
Do you wait 12 weeks for confirmation to begin treatment if patient is declining?
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?
Would you favor the use of any particular biologics over others?
Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?
I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...
Patient has no current evidence of underlying vasculitis or malignancy.
Does your evaluation hinge on nonresolution with warming? How extensive is your workup?
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...
Such as oral methylprednisolone, dexamethasone, prednisolone, etc.
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...
How do you decide if it may be safe to continue immunotherapy?
Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...
Would you consider this for patients on B-cell depleting therapies or more broadly for other immunosuppressive agents?
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?
Are there specific features that suggest drug-induced uveitis versus de novo uveitis?
There is some emerging evidence that there is an inflammatory component.
To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)
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