General Rheumatology&nbsp;&nbsp;&nbsp;

When screening for malignancy, do you order CT with contrast (or) both with and without contrast?

Do you need to have the non-contrast study when ordering the CT C/A/P with contrast, and what does the non-contrasted show that requires it in additio...

What is your approach to long term lab monitoring for Sjogren's disease activity?

i.e. which labs do you follow (such as complements, cryoglobulins, beta-2-microglobulin, SPEP, etc) and what frequency?

When trying to increase infliximab for active disease (inflammatory arthritis or sarcoidosis), do you prefer to increase dosage or reduce frequency between doses?

How do you approach a patient with idiopathic anterior uveitis who has ongoing disease despite adalimumab every two weeks?

How do you approach management of a patient with multiple lung nodules and low titer +CCP but no active joint symptoms suggestive of RA?

Negative RF. No evidence of inflammatory arthropathy on hand MRI. ANCA negative. Lung nodule bx: benign fibrovascular tissue with areas of smal...

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

11 Answers available

What biologic or conventional/synthetic DMARD would you use as a steroid sparing agent in a patient with GCA and a history of diverticulitis?

What are your recommendations for perioperative management of DMARDs and biologics in patients undergoing bariatric surgery?

The bariatrics department wants patients to hold immunosuppressants for 4 months prior to bariatric surgery.

What is your approach to treatment of airway involvement, such as recurrent bronchial stenosis, in relapsing polychondritis?

Are there specific immunosuppressive agents effective for this manifestation?

How do you approach treating a patient with RA and cirrhosis who did not respond to csDMARDs?

Do you check the Duffy-null phenotype before starting azathioprine and in which patients?

What is your typical steroid taper regimen for managing RA flares?

What is the recommended fungal workup in an immunocompromised patient after 5 days of persistent fever?

Do you involve additional specialists, such as ENT, to further evaluate? Is there a particular algorithm followed by your institution, or it is just d...

Is there any benefit to checking serum viscosity in patients with autoimmune disease and headaches/migraines to see if aspirin or clopidogrel may be beneficial?

SLE, APLS, Sjogrens, and RA can sometimes have associated serum hyperviscosity. Is the standard viscosity test sensitive enough for these conditions a...

Are there any successful disease modifying therapy for diffuse idiopathic skeletal hyperostosis (DISH)?

The patient has severe flowing ossification of the anterior and posterior longitudinal ligaments causing nerve compression. HLA B27 negative and SI jo...

When starting stress dose steroids for patient with primary adrenal insufficiency, how do you decide whether to start hydrocortisone 100 mg every 8 hours versus 50 mg every 6 hours?

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

How do you integrate next-generation sequencing with traditional culture methods to improve the identification of fungal pathogens, especially in cases where routine cultures are negative when evaluating suspected prosthetic joint infections?

How do you counsel and manage joint pain after isotretinoin treatment?

Have you found dose adjustments to be effective?

Are SGLT2 inhibitors contraindicated in patients with osteoporosis and history of vertebral and hip fractures?

How do you treat nocturnal leg cramps?

Have you tried Vitamin K2? In light of a recent publication: Tan et al., PMID 39466236

How would you approach management of retroperitoneal fibrosis causing ureteral compression that has already caused irreversible loss of kidney function?

Renal perfusion scan shows 14 % perfusion on affected side.

How do you approach management of recurrent idiopathic pleuropericarditis?

What is your approach to monitoring patients referred for high titer +RF and +CCP but without active symptoms of inflammatory arthritis?

X-rays without inflammatory changes. RF >120, CCP >250.This question is part of a collaboration with RheumMadness and is specifically in referen...

Would you use febuxostat for an African-American patient with gout and previous cardiovascular events (stroke, MI) who tested positive for HLA-B*5801?

Does synovial biopsy provide diagnostic value in undifferentiated inflammatory arthritis?

This question is part of a collaboration with RheumMadness and is specifically in reference to: STRAP Trial: Biopsy Guided Treatment for RA

How do you approach the significance of +RNP III antibody in a patient with positive ANA but no other signs or symptoms of systemic sclerosis?

No history of malignancy. No Raynauds.

What is your approach to the management of Bell's palsy that has not improved after six months?

How long do you recommend that a patient wear a mask when resuming biologic infusions following a recent upper respiratory infection?

Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?

How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?

Patient with +ANA 1:2560 for >10 years; rest of serologies are negative. Complements are normal. Negative dsDNA. Antiphospholipid labs are negative...

Should TNF inhibitors be held in patients undergoing radiation therapy?

Is there a risk of increased radioresistance or secondary malignancy (or conversely, toxicity) for patients on TNF inhibitors...

In a patient with SJIA who has been stable on Anakinra however is now planning to conceive or becomes pregnant, would you consider switching to Cimzia?

How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Cost Effectiveness of HCQ Screening.

In the treatment of lupus nephritis, which patients may benefit from the use of rituximab or other B-cell depleting agents during induction?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Obinutuzumab in Lupus Nephritis

In a patient with isolated HLA B27+ anterior uveitis, how long would you continue immunosuppressive therapy?

The patient has no extraocular features of a spondyloarthropathy and is on methotrexate. No active eye disease for past 1 year.

How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?

Normal Vitamin D, bone scan showed osteoarthritis.

How do you interpret small joint effusions seen on ultrasound without power doppler signal in the setting of compatible inflammatory symptoms (i.e morning stiffness)?

Is there any role for administering another course of recombinant zoster vaccine (Shingrix) in a previously vaccinated patient with RA, who is in clinical remission on JAK inhibitor but has had a breakthrough shingles infection?

The last SHINGRIX was about 4 years ago and both doses were given.

What is the most impactful career advice you have received from a colleague or mentor?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeting. This question was inspired by the ...

How do you approach an asymptomatic patient with evidence of intense radiotracer activity at the left sternoclavicular joint on bone scan with a history of SAPHO syndrome on Humira?

Patient is asymptomatic and on therapy but has the finding on bone scan. Do we add therapy or change or do nothing and monitor only?

Do you generally utilize calcium channel blockers on an as needed basis for patients with Raynaud's phenomenon?

Do you generally feel they work well? Have patients tried using this a few days before an activity, such as skiing? Especially for otherwise healthy, ...

Do you continue TNF inhibitors in patients with a new diagnosis of CLL?

Patient with long standing history of HLAB27 associated uveitis on adalimumab and new diagnosis of CLL.

What is the interpretation of an IGRA with positive TB wells and negative nil and negative mitogen wells?

A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...

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

What is the role of the rheumatologist in recommending and providing GLP-1 medications to their patients given the benefits across many disease domains including osteoarthritis?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeting. This question was inspired by the ...

Is it better to give dose 2 of the mRNA 2024-2025 Covid-19 vaccine at month 2 or month 6 after dose 1 in moderately immunocompromised patients?

Is there any data to suggest one time-frame is better than the other? The CDC states give "2024–2025 Dose 2 (Moderna, Novavax or Pfizer-BioNTec...

Can lupus anticoagulant be positive despite a normal aPTT?

How often does this occur and does this lower your suspicion for a "true" or clinically significant lupus anticoagulant?

Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?

Patient with chronic urticaria and rheumatoid arthritis. What would be the safest biologic option for RA?

In patients with diffuse scleroderma and symptomatic lower extremity venous insufficiency, would you recommend treatment with endovenous laser/ablation?

The patient has tried conservative measures with compression stockings.

For patients with VEXAS syndrome and good response to azacitidine, what duration of therapy do you consider?

How do you decide to trial a patient off treatment? When do you consider spacing therapy and at what frequency?

What are your practice recommendations regarding live vaccinations in infants/children of women who are currently on DMARDs and are breastfeeding?

Does the recommendation change based on the DMARD?

How do you approach the management of recurrent episcleritis in a patient with RA that is otherwise well-controlled?

No active joint disease, patient on Hydroxychloroquine and Cimzia. Normal ESR/CRP.

How would you treat an asymptomatic patient with a positive Blastomyces antibody, evidence of prior granulomatous lung disease on imaging, and who may require immunosuppression in the future?

Do you recommend genetic screening for FMF in asymptomatic first-degree relatives with a strong family history (multiple family members, severe/refractory disease)?

Does receiving IVIG confound the result of SPEP and/or UPEP?

Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?

How do you treat idiopathic acute anterior uveitis that recurs immediately after a course of topical corticosteroids?

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?

How would you approach management of a patient with longstanding history of SLE, but having active psoriasis?

SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...

What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?

For example, is captopril dialyzable?

Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?

Can Dupixent (dupliumab) be safely used in patients who are taking other biologics for rheumatic disease?

What is your approach to differentiating RA-ILD from medication toxicity (I.e. from methotrexate)?

Is there a benefit to having a transition period in which a patient continues following with their previous pediatric rheumatologist while establishing care with a new adult rheumatologist?

What do adult rheumatologists need to understand about pediatric diseases?

How do you approach evaluation and management of a patient with recurrent monoarticular inflammatory arthritis of unclear etiology?

Synovial fluid analysis: cell count >100,000, > 80% neutrophils. Gram stain, cultures (including fungal and mycobacterial), synovial biopsy, and...

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?

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

For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?

UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...

How long do you maintain patients with anti-synthetase syndrome on Rituximab?

The patient was treated with two doses of Rituximab and on MMF. Now with stable lung function and normalized CK.

What would be the preferred treatment option for PMR if patient develops gastric perforation soon after initiation of steroids?

How would you approach management of nodular scleritis in the setting of suspected GCA?

Can nodular scleritis be a presenting manifestation of GCA?

How long do you treat retroperitoneal fibrosis with immunosuppression?

What imaging do you use to monitor disease activity? Imaging only shows chronic, fibrotic lesions making it hard to assess disease activity.

What are some of the biggest challenges you run into when patients transition from pediatric to adult care?

Should the age at which patients transition from pediatric to adult care differ depending on the disease diagnosis?

What nuances do adult rheumatologists need to understand about pediatric diseases?

Do you recommend adjusted adult cancer screening for patients who have been on long term biologics and/or tsDMARDs since childhood?

How would you approach management of a patient with ESRD on the transplant list who is found to have high titer APS labs (ACL, B2GP1, LAC)?

What are some strategies to help teach patients transitioning from pediatric to adult care to become more independent with respect to their care and less dependent on their caregivers?

How do you discuss sexual health with pediatric patients transitioning to adult rheumatology care when the patient is accompanied by parents or caregiver?

In a patient with low titer +anti-SAE antibody and known ILD, but no other clinical features of dermatomyositis, how would you approach further testing or would you treat the patient as dermatomyositis associated ILD?

How often do you see bony erosions in patients with Lyme arthritis?

What is your treatment approach for a young female who has an idiopathic small right elbow effusion with synovial thickening that has resulted in limitation in her range of motion?

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?

When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?

Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?

Are there any concerns with live vaccine innoculation and patients who are on denosumab?

How do you approach medication management in patients with RA when transitioning from csDMARD triple therapy to anti-TNF?

Which csDMARD do you taper in order, and is there a tapering strategy (duration/dose)?

Are you comfortable with using NSAIDs in a patient on methotrexate for inflammatory arthritis?

Given the drug-drug interaction, do you monitor more closely for methotrexate toxicity, counsel on symptoms of methotrexate toxicity, or avoid the com...

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.

What is your approach to management of hyperlipidemia in patients taking JAK inhibitors?

How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?

Do you combine methotrexate and leflunomide for the treatment of RA?

How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?

Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.

What is the maximum dose of leucovorin that you use with methotrexate?

Do you continue methotrexate in patients with inflammatory arthritis who develop non-melanomatous skin cancer while on therapy?

In patients with sicca symptoms and positive SSA/SSB how often do you perform other diagnostic testing such as salivary gland ultrasound, biopsy, Shirmers, ocular staining, stimulated salivary flow, etc?

Is the diagnosis of Sjogren's mostly clinical in a patient with a consistent history and physical with positive serologies?

Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?

What is the typical timeline for remission of autoimmune hypoglycemia?

How would you manage cardiac sarcoid with intolerance/contraindications to methotrexate, azathioprine, and mycophenolate/mycophenolic acid and that has proven refractory to adalimumab and infliximab as determined by PET?

Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?

Would you switch azathioprine to a different immunosuppressant if a controlled patient with SLE develops melanoma and/or non-melanoma skin cancer?

When considering a biologic for seropositive RA after failure of methotrexate or triple therapy, do you consider using abatacept as a first line biologic or would prefer choosing TNFi?

Do you avoid hyaluronic acid injections in patients with chondrocalcinosis on imaging?

How do you approach the work up of pulmonary artery aneurysm in the absence of other clinical features of Behcet’s?

Do you find HZV titers useful in diagnosing shingles sine herpete?

How would you approach management of a patient with checkpoint inhibitor induced psoriatic arthritis?

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...

What is your approach to differentiating tender spots (as in fibromyalgia) and enthesitis (as in axSpA)?

What is your approach to work up for patients referred for early onset osteoarthritis?

How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?

When would you consider utilizing bone scintigraphy in the assessment of inflammatory arthritis?

How are you utilizing vibratory devices for reducing pain associated with injection or procedures?

In which situations or patient populations do you find this useful? How is it sterilized?

How do you approach treatment of a patient with active RA and a history of Lynch Syndrome?

Does your choice of DMARD/biologics change due to increased risk of malignancy?

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 approach to evaluation and management of a patient with Blau Syndrome and GI manifestations?

How do you approach management of Adult Onset Still's disease in a patient with ongoing fatigue and inflammatory joint pain despite methotrexate, colchicine, canakinumab and tocilizumab?

Heritable autoinflammatory gene testing negative. Is there a role for TNF inhibitor?

How do you decide when to obtain genetic testing for suspected autoinflammatory conditions in adults?

How do you approach hypocomplementemia in Sjogren’s without features of lymphoma?

Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?

Do you recommend sending an autoimmune work up for patients with recurrent nephrolithiasis and 24 hour urine chemistries consistent with distal renal tubular acidosis?

Do you prefer celecoxib over a nonselective NSAID in patients with chronic kidney disease?

What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?

Would it be safe to resume and if so, when?

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

How do you monitor patients with incidentally found high titer anti-smooth muscle antibodies without stigmata of liver disease?

How do you approach evaluation for underlying rheumatologic disease in patients with chronic asymptomatic thrombocytopenia?

Thrombocytopenia is moderate (80-100,000 microL). No concomitant cytopenias present.

How do you approach management of adult patients with CVID and sarcoid-like syndrome?

What is your approach to differentiating and managing DMARD-induced nodulosis (induced by methotrexate or leflunomide for example) from "de novo" RA nodules in seropositive RA patients?

Do you restrict topical diclofenac use in your patients with chronic kidney disease?

How do you approach patients referred for C1-2 pannus/erosions without clinical findings or serologies consistent with RA or CPPD arthropathy?

What do you recommend to patients when they are having an acute flare of fibromyalgia symptoms?

What is your approach to monitoring for hepatic fibrosis in chronic methotrexate use?

Do you frequently order liver biopsies for these patients?This question is part of a collaboration with RheumMadness and is specifically in reference ...

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

Is there utility in monitoring IgE levels in patients with IgG4-RD?

Do you recommend Vitamin D and omega 3 fatty acid supplementation for prevention of autoimmune disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Prevention of Autoimmune Disease: Vitamin D and O...

What characteristics make a PMR patient a good candidate for sarilumab?

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...

What is your approach to a patient with IgG4RD with past pulmonary involvement (biopsy proven) managed with steroids alone, now with new hematuria/proteinuria, but stable renal function?

Would you obtain renal biopsy first or treat with additional immunosuppression for suspected renal involvement related to IgG4?

How do you counsel patients on the use of topical nitroglycerin for Raynaud's?

What formulation of topical nitroglycerin do you use?

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

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...

Would you feel comfortable adding benlysta to patient already taking both mycophenolate and tacrolimus (and hydroxychloroquine) who still has some evidence of active lupus nephritis?

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

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

Do you avoid the use of hydroxychloroquine in patients with psoriasis and/or psoriatic arthritis?

Do you have concerns with the use of oral contraceptives in patients on JAK inhibitors given the black box warning for thromboembolic events?

How has this impacted your counseling and management?

What would be your approach to a patient with Scleroderma/Myositis overlap syndrome (+anti-Ku) and active inflammatory eye disease despite high dose mycophenolate?

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)?

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?

Do you counsel your patients on the potential decreased effectiveness of oral contraceptives while on Sarilumab?

If so, do you routinely recommend use of an additional form of contraception?

How do you approach GI prophylaxis (e.g., PPIs, H2 blockers) in patients on long-term NSAIDs?

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

At what point do you consider a patient to have relapsing PMR?

How much cumulative prednisone exposure do you tolerate and how many attempts at tapering will you pursue before considering addition of a steroid spa...

How do you approach follow up of young patients with isolated +ANA, but no current clinical signs or symptoms of SLE?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Antibodies Before SLE.

Do you typically screen patients for antiphospholipid antibodies in autoimmune diseases besides lupus in the absence of a clotting event?

Do you consider anti-viral prophylaxis in patients taking JAK inhibitors who have recurrent uncomplicated Zoster infection, but would prefer not changing therapy?

How do you approach management of a patient with persistent EBV infection and MAS despite treatment with Rituximab, anakinra and canakinumab?

Would you consider alternative B cell depleting therapies such as ofatumumab or ocrelizumab?

Does hepatitis B vaccination reduce the risk of HBV reactivation associated with immunosuppressive therapy?

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

How do you approach a negative ANA and positive dsDNA in patients with arthralgia, hair loss, or other UCTD features?

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

How do you approach management of a patient with idiopathic PAH and +ANA, but no other current symptoms/signs of active rheumatologic disease?

Is it safe to combine mycophenolate and adalimumab for management of pulmonary sarcoidosis in a patient that could not tolerate methotrexate?

How would you approach treatment of active inflammatory arthritis in a patient with MCTD (+RNP/+Chromatin) and stable ILD who has failed MMF, azathioprine and methotrexate?

Would you consider belimumab over a TNF inhibitor for inflammatory arthritis? Which agent would be more beneficial for the lung disease?

At what point would you consider anticoagulation in a pregnant patient with lupus nephritis and non-nephrotic range proteinuria?

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?

What treatment options do you recommend in a patient with idiopathic granulomatous mastitis that has not improved on steroids and methotrexate?

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?

How will you approach tapering sarilumab in patients with PMR in remission?

After what interval of sustained remission will you attempt to taper, and will you do so by first widening the dosing interval?

What are your top takeaways from ACR Convergence 2023?

Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?

What is your approach to evaluation in patients who present with erythromelalgia?

How will you approach drug sequencing in patients with PMR given the SAPHYR data?

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...

How will you adjust your approach to steroid taper in patients with PMR also on sarilumab?

What baseline and ongoing testing do you recommend for patients with PMR who are going to be on a prolonged steroid taper?

Do you universally perform baseline DEXA and Hgb A1C? How often are you obtaining routine labs?

How do you differentiate active vasculitis from pregnancy complications such as pre-eclampsia and HELLP in a patient with AAV?

How do you approach the timing of Rituximab during pregnancy in a patient with life or organ threatening autoimmune disease?

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?

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

0 Answers available

Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?

Do you stop TNF inhibitors during the third trimester of pregnancy?

What is your approach to patients with severe sicca symptoms and history of B Cell lymphoma?

Patient has received treatment with Rituximab and is taking hydroxychloroquine.

What is your approach to tapering chronic steroids in patients who are at high risk of HPA suppression?

For example, patients who have been maintained on 5mg of prednisone for years without previous tapering attempts and the rheumatic disease is not acti...

How do you approach pre-conception counseling in males who are on medications for which there is limited or no data such as Jak inhibitors, apremilast, or belimumab?

Do you hold rituximab for cataract surgery?

If so, when do you recommend timing for the cataract surgery?

How would approach the management of a patient with significantly positive anticardiolopin and beta 2 glycoprotein antibodies in the absence of any clotting (including obstetric) history but with significant thrombocytopenia (but no other features of active connective tissue disease)?

How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?

Have you seen drug induced SCLE from IL-17 inhibitors?

And if so, what is your approach to the diagnosis?

How would you approach management of incidentally identified unilateral retinal vasculitis with subsequent labs revealing +P-ANCA?

Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.

Is polymyalgia rheumatica associated with increased toxicity for lung SBRT?

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?

In a patient with active spondylarthritis and uveitis who cannot take TNF inhibitors, what is your next agent of choice?

Would you consider a biologic or JAK inhibitor to manage active PsA in a patient on chronic antibiotic therapy if they had previously failed all conventional DMARDs (including apremilast)?

Patient is on antibiotics for chronic spinal hardware infection.

What is your approach to continuing or altering therapy when inheriting a patient with combined biologic immunosuppression that is in excess of guidelines?

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...

Would you have a patient temporarily discontinue methotrexate while receiving a FAST or FAST FORWARD regimen for breast irradiation?

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...

What is your approach to management of chronic neutropenia in a patient with Sjogren’s who was recently diagnosed with metastatic endometrial cancer and plans to start chemotherapy?

ANC <500

How do you manage patients with systemic sclerosis and chronic thrombotic microangiopathy on renal biopsy, but no other evidence of scleroderma renal crisis?

Patient with nephrotic range proteinuria, but there is no evidence of active TMA on renal biopsy.

Do you find MRI helpful to differentiate early erosive OA from psoriatic arthritis when early X-ray changes in both conditions may be hard to distinguish?

What is your approach to management of elevated liver enzymes in patients who recently started treatment with tocilizumab?

How do you approach dosing of anakinra in MAS?

What is your approach to evaluating a patient with known rheumatologic disease and elevated free kappa:lambda ratio, but no evidence of monoclonal immunoglobulins?

What is your approach to rheumatologic disease management during the current methotrexate shortage?

How long would you wait to start another biologic agent after Rituximab administration in patients with dermatomyositis and refractory inflammatory arthritis (intolerant to traditional DMARDs)?

Patient with dermatomyositis on rituximab with refractory inflammatory arthritis. Intolerant of traditional DMARDs such as methotrexate, leflunomide, ...

Would you consider re-irradiation for recurrence of Dupuytren's Contracture?

It's been 5+ years after the first course. If you decide to re-irradiate what dosing schema would you use?

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

This question is part of a collaboration with RheumMadness and is specifically in reference to: Etanercept + Methotrexate.

How would you manage tubulointerstitial nephritis and renal tubular acidosis (RTA) in a patient with Sjogren's who is pregnant?

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?

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?

How do you counsel patients regarding alcohol intake when prescribing DMARDs other than methotrexate?

Such as Leflunomide, Sulfasalazine, Mycophenolate or Azathioprine, since all of these medications have potential to cause liver enzyme elevation and i...

How do you approach management of patients with active RA and recurrent non-severe C.diff?

(Patient with active RA despite hydroxychloroquine)

How do you manage injection site reactions in patients on subcutaneous biologics such as TNF inhibitors?

In what cases do you discontinue the medication?

How long do you expect gastrointestinal side effects of leflunomide to persist after stopping treatment?

Do you generally recommend starting nintedanib prior to immunosuppressive therapy in a patient with CTD-ILD?

Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedan...

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?

Would you use TNF inhibitors in patients with features of SLE, but active peripheral and axial spondylarthritis?

Patient with sacroiliitis on imaging, failure of two NSAIDs.

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 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?

Do you combine oral and topical NSAIDs for pain relief?

Would you be comfortable using a JAK inhibitor in a patient with baseline thrombocytosis?

Would the etiology of the thrombocytosis play a role in your decision-making?

What target do you utilize in clinical practice for defining disease remission in RA?

This question is part of a collaboration with RheumMadness and is specifically in reference to:BeSt TrialMeasurement of Patient Outcomes in Arthritis

Do you recommend chlorhexidine mouth rinse for prophylaxis against oral complications in patients undergoing dental work who are immunosuppressed?

Would you consider re-challenging a patient with rituximab after they experienced delayed neutropenia?

In a patient for whom rituximab is the best option for their disease management.

How do you differentiate the normal feeding vessel to the lunate from an erosion or power doppler signal on ultrasound?

How do you counsel patients about the malignancy risk associated with azathioprine?

Do you recommend patients continue folic acid for a few weeks after methotrexate discontinuation?

How do you approach the usage of hydroxychloroquine in patients with rheumatologic conditions and baseline cardiomyopathy or heart failure?

Do you continue to utilize ESR and CRP in patients on tocilizumab?

How do you approach the use of hydroxychloroquine in patients with a history of visual field defect from another cause such as macular degeneration or diabetic retinopathy?

Is there utility in obtaining pericardial fluid autoimmune labs such as ANA or RF in patients with recurrent idiopathic pericardial effusions, but no other clinical or serologic evidence of rheumatic disease?

How do you approach evaluation of hypocomplementemia in a patient with arthralgias and a history of Hodgkin's lymphoma treated in the past?

ANA and ENA negative

How do you manage severe Raynaud's phenomenon with ulceration in scleroderma patients that is refractory to oral agents (CCBs, PDEis, ARBs, and ERAs)?

Is there any role of sympathectomy in Raynaud’s disease?

How do you approach oral DMARD and/or biologic selection in patients with RA and a history of gastric bypass or whom are planning bariatric surgery?

How do you counsel patients regarding contraception use while taking mycophenolate/mycophenolic acid?

Would you consider use of belimumab in a patient with SLE with recurrent anterior uveitis who failed other treatment options?

Patient failed topical ocular therapies, methotrexate, azathioprine.

In which clinical scenarios is relying on the urine protein-to-creatinine ratio as a measure of proteinuria unreliable, and interpretations should be made looking at urine protein and urine creatinine separately?

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?

What is your approach to patients who present with unilateral Raynaud's?

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?

Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?

What is your approach to the use of NSAIDs in patients with a history of gastric sleeve/bypass?

How do you interpret elevations in ESR and CRP in the setting of increased BMI?

When do you consider discontinuing Pegloticase in a patient with tophaceous gout who has had excellent response to therapy?

What is your approach to patients with PMR on steroids over a prolonged initial course who start to experience weakness concerning for steroid myopathy?

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?

What is your approach to timing of medications like Rituximab and Cyclophosphamide around plasmapheresis in patients on daily PLEX?

What is the appropriate management of arthralgias associated with bosutinib?

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

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

Would you consider continuing a biologic for difficult to control autoimmune disease in a patient with a recent diagnosis of a surgically curable solid malignancy?

Would you favor the use of any particular biologics over others?

Are there any concerns utilizing apremilast for psoriatic arthritis in patients who are also taking roflumilast for COPD?

What are your top takeaways from ACR 2022?

How do you approach the continued use of TNF inhibitors in a patient with inflammatory arthritis who develops a positive dsDNA without clinical evidence of drug-induced lupus?

What is your approach to tapering therapy in a patient with recurrent pericarditis now well-controlled on rilonacept?

How do you approach Covid vaccine counseling in patients with rheumatic disease and history of pericarditis/serositis?

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?

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

What is your approach to using apremilast for psoriatic arthritis in patients with history of depression?

How do you assess potential fetal harm in patients who have unplanned pregnancy while taking teratogenic medications?

When considering the use of DOACs in APLS, does the number of positive APLS antibodies influence your decision?

What is your treatment algorithm for management of retroperitoneal fibrosis that does not respond to high-dose glucocorticoids?

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

Do you avoid intra-articular and bursa/tendon sheath corticosteroid injections in patients with a history of avascular necrosis?

How do you manage nausea in the setting of hydroxychloroquine use?

Do you utilize ethyl chloride spray prior to steroid injections?

Would you intensify therapy in IgG4 related disease based solely on a persistently significantly elevated IgG4 level when all disease manifestations and inflammatory markers have normalized?

In patients who develop a VTE, what conditions do you consider as persistent, provoking risk factors, and at what point are they controlled enough to stop anticoagulation?

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

How would you manage polymyalgia rheumatica refractory to prednisone, methotrexate and tocilizumab?

Patient has no current evidence of underlying vasculitis or malignancy.

How do you evaluate patients who have panuveitis without any systemic symptoms?

Do you refer all patients with a Beighton score over 5 to genetics for further assessment?

Would you favor stopping hydralazine in a patient requiring it for refractory hypertension if they also have a high titer ANA in the absence of any SLE symptoms?

What is the role of synovectomy in the diagnosis and management of patients with inflammatory arthritis?

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

How do you evaluate livedo reticularis (not livideo racemosa)?

Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

When do you consider vascular imaging in patients with Raynaud's and what type of imaging modalities do you utilize?

How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?

What is your approach to workup for an underlying disorder in a patient with bilateral hip avascular necrosis?

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...

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

Such as oral methylprednisolone, dexamethasone, prednisolone, etc.

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

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

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

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

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

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?

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?

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

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

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

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

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 ...

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

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?

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...

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

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

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?

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

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?

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?

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

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

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

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?

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.

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?

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

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 management of patients with inflammatory arthritis who are asymptomatic but develop radiographic progression?

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

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

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

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

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

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

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

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

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

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

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?

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

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

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

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)

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

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

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

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

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

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

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

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

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?

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