General Rheumatology   

Questions discussed in this category

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

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

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?

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 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.

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

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...

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? 

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. 

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?

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...

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...

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 ...

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 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)

Papers discussed in this category

Arthritis Rheumatol, 2016 Jan

Arthritis and rheumatism, 1982-11

Arthritis and rheumatism, 2012-08

, 2019 Aug 06

Arthritis Rheum.,


Arthritis care & research, 2017-03

Clin Exp Dermatol, 2018 May 24

Eur J Rheumatol, 2017 Feb 23

Rev Bras Reumatol Engl Ed, 2016 Mar 16

Southern medical journal, 2016-11

Annals of the rheumatic diseases, 2011-05

Atherosclerosis, 2015 Aug 28

N Engl J Med, 2020 Apr 29

JAMA network open, 2018-11-02

The Journal of arthroplasty, 2008-02

N Engl J Med,

Mediterr J Rheumatol, 2020 Jun 11

Clin Infect Dis,

Cochrane Database Syst Rev, 2013 May 31

British journal of cancer, 2023 Feb 04

Ann Rheum Dis, 2017 Mar 23

Clin Pharmacokinet,


Arthritis and rheumatism, 2001-12

J Med Food,

Int J Clin Pract, 2021 Apr 29

Nutrients, 2020 Dec 11

Current rheumatology reports, 2009-10


Curr Rheumatol Rep, 2021 Jan 26

Kidney international, 2009-12

Clinical journal of the American Society of Nephrology : CJASN, 2010-07

Journal of the American Society of Nephrology : JASN, 2010-08

Am J Kidney Dis, 2016 Sep 16

J Rheumatol, 2004 Aug

N Engl J Med, 2021 Aug 04

Curr Opin Rheumatol,

BMJ Open, 2019 May 05

Rheumatol Int, 2021 Jan 29

Rheumatology (Oxford),

Z Rheumatol,

Journal of neurovirology, 2018-06

Blood Adv,

Annals of the rheumatic diseases, 2012-08


Arthritis Rheumatol, 2020 Jan 07

J Rheumatol, 2013 Nov 15

Arthritis Res Ther, 2005 Mar 01

JAMA Ophthalmol, 2015 Oct

JAMA, 2022 Oct 11

Front Immunol, 2021 May 14

J Rheumatol, 2019 Apr 01

RMD Open,

Curr Med Chem,

Pathology, 2017 Mar 11


The Lancet. Respiratory medicine, 2016-09

Annals of the rheumatic diseases, 2015-06

Neth J Med,

Medicine (Baltimore),

Ann Rheum Dis, 2016 Oct 03

ACR Open Rheumatol, 2021 Aug 25

Arthritis Res Ther, 2021 Mar 22

J Orthop Translat, 2020 Jan 06

Annals of internal medicine, 2018-01-16

J Immunother Cancer,

Autoimmun Rev, 2012 Nov 30

Arthritis Rheum,

Arthritis care & research, 2014-08

Intern Med J, 2022 Mar 16

Ann Rheum Dis, 2016 Feb 17

Support Care Cancer, 2019 Dec 13

Int J Surg Case Rep, 2020 Nov 22

Eur J Orthop Surg Traumatol, 2019 Sep 19

Annals of the rheumatic diseases, 2019-10

J Thromb Haemost, 2020 Nov 29

Front Cardiovasc Med, 2021 Aug 03

Medizinische Klinik (Munich, Germany : 1983), 2002-11-15

Journal for scientific research. Medical sciences, 2001 Apr

Clin Microbiol Infect, 2018 Feb 07

Arthritis & rheumatology (Hoboken, N.J.), 2018-03

N Engl J Med, 2020 Nov 16

N Engl J Med,

Ann Rheum Dis, 2022 Sep 22

Rheumatology (Oxford), 2014 Sep 16

Current medical research and opinion, 2016-12

Open access rheumatology : research and reviews, 2016

PET Clin, 2020 Feb 11

Rheumatology (Oxford), 2022 Jul 22

Arthritis and rheumatism, 2008-09

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014-12

Curr Rheumatol Rep, 2022 Feb 15

Arthritis Care Res (Hoboken), 2017 Dec

JAMA, 1999 Dec 08

Reumatologia, 2020 Feb 28

Pediatr Blood Cancer, 2021 Oct

Int. J. Radiat. Oncol. Biol. Phys.,

The New England journal of medicine, 2003-10-16

Rheumatology (Oxford, England), 2018-09-01

Lupus, 2021 Jan 05

Arthritis Rheumatol, 2018 Jun 27

J Manag Care Spec Pharm, 2022 Jul 01

Diagnostics (Basel), 2021 Sep 01

Front Immunol, 2021 May 27

Arthritis Rheumatol, 2020 Apr

Immunol Invest, 1985 Jun

Int J Environ Res Public Health, 2021 Aug 01

Arthritis Care Res (Hoboken), 2023 Feb 10

J Am Dent Assoc, 2016 Jan 05

Eur J Radiol, 2020 Jan 17

Joint Bone Spine, 2019 Jan 31

Arthritis Rheumatol, 2020 Sep 6

Arthritis and rheumatism, 2011-03

The Journal of rheumatology, 2013-05

Arthritis & rheumatology (Hoboken, N.J.), 2017-10

Arthritis Rheum, 2004 Oct

N. Engl. J. Med., 2019 May 20

N Engl J Med, 2019 Sep 29

Ther Adv Musculoskelet Dis, 2020 Nov 24

Cleveland Clinic journal of medicine, 2016-01

The British journal of dermatology, 2019-11

J Am Acad Dermatol, 2020 Sep 04

Rheumatology (Oxford),

Medicine (Baltimore), 2016 Aug

BMJ, 2021 Jun 23

Arthritis and rheumatism, 2010-05

Ann Clin Transl Neurol, 2020 Jul 06

Lupus, 2023 Apr 10

Lupus Sci Med, 2022 Jan

Nat Rev Nephrol, 2015 Nov 16

Arthritis & rheumatology (Hoboken, N.J.), 2018-06

Nat Med, 2022 Jun

Nat Med, 2022 May 19

Curr Opin Rheumatol, 2013 May

Arthritis Res Ther, 2014 Apr 30

Annals of clinical and laboratory science, 2008

International journal of general medicine, 2019 Sep 02

Ophthalmology and therapy, 2023 Aug 21

Ann Rheum Dis, 2020 Jan

Mediterranean journal of rheumatology, 2022 Mar 31

Annals of the rheumatic diseases, 2018-09

Arthritis & rheumatology (Hoboken, N.J.), 2019-02

RMD open, 2020 Feb

The New England journal of medicine, 2014 Jun 05

Trials, 2022 Sep 05

Clinical and experimental dermatology, 2021 Mar 09

JAAD case reports, 2019 Mar 01

Dermatologic therapy, 2020 May 03

The Journal of allergy and clinical immunology, 2012 Feb 14

Blood, 2022 Jun 23

Best practice & research. Clinical rheumatology, 2019 Dec 19

Blood, 2011-02-03

Arthritis Care Res (Hoboken), 2020 Apr

Journal of clinical medicine, 2023 Feb 24

Chest, 2021 Feb

The ocular surface, 2015 Jan 15

Arthritis and rheumatism, 2011-12

N Engl J Med,

Arthritis Rheumatol, 2017 Apr 07

Lancet (London, England), 2011 Feb 04

Annals of internal medicine, 2004-10-05

The New England journal of medicine, 2023 Oct 05

Annals of the rheumatic diseases, 1996 Apr

The Journal of rheumatology, 1996 Sep

International journal of clinical pharmacology and therapeutics, 2021 May

Annals of the rheumatic diseases, 2022 Feb 24

JAMA, 2022 Sep 20

Ann Rheum Dis, 2015 Oct

Arthritis care & research, 2023 Aug 10

Arthritis care & research, 2023 Oct 26

Rheumatology advances in practice, 2021 Nov 27

Rheumatology (Sunnyvale, Calif.), 2015 May 07

Annals of the rheumatic diseases, 2013 Jul 10

Journal of behavioral medicine, 2023 Jun 29