Questions discussed in this category
Are you aware of any data regarding relative risk of molluscum contagiosum infection in reference to DMARDs/biologics?
Patient previously trialed two anti-TNFi and Tocilizumab. Avoiding Rituximab due to positive JC virus testing.
Patient has had previous failure of methotrexate. Would you switch to alternative (TNFi or Rituximab) or continue abatacept with regular dermatology...
X-rays without inflammatory changes. RF >120, CCP >250
Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?
While remission rates after lowering or discontinuing therapy are lower, there is still a population of patients who do not require full-dose therapy ...
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...
What is your most and least preferred? In case of cancer in remission and in case of non-remission?
How do you counsel patients in this scenario?
Arthritis did not respond to HCQ.
Do you consider the appearance of a new rheumatoid nodule as a sign of RA activity?
Are there certain surgeries (including orthopedic) that you recommend continuing biologic DMARDs?
Does your choice of DMARD/biologics change due to increased risk of malignancy?
This question is part of a collaboration with RheumMadness and is specifically in reference to: NORD-STAR (Østergaard et al., PMID 3742364...
Do you advocate to taper the TNF-i or simply continue to monitor for long term adverse events? This question is part of a collaboration with Rheu...
Is it different between DMARDs (csDMARDs, biologic DMARDs, and target synthetic DMARDs)?
Is the interaction considered severe?
Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?
Patient taken off methotrexate.
Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?
Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?
Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...
While classically described as seen in seropositive patients, have they been reported in seronegative RA?
Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want ...
Patient already on methotrexate and plaquenil.
Patient previously failed abatacept and Rituximab.
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...
Data is clear that we should hold methotrexate at least one week after COVID and flu vaccines. How do you approach methotrexate management around Shin...
In what cases do you discontinue the medication?
Would you switch to a non TNFi biologic or continue current regimen with careful monitoring for evolution of lupus manifestations?
This question is part of a collaboration with RheumMadness and is specifically in reference to:BeSt TrialMeasurement of Patient Outcomes in Arthritis
Patient has failed methotrexate and adalimumab.
Studies are now being pursued to ability the of implantable bioelectric device stimulation of the vagal nerve to attenuate disease activity in patient...
Given the controversy in the literature regarding TNFi or MTX associated lymphoma in patients with RA.
Continue MTX with monitoring of LFTs vs switching to another oral DMARD (aza, lef) vs GI for fibroscan?
Infection risk being primarily chronic venous stasis ulcers
Data is mixed based on the results of ORAL surveillance, STAR-RA and nationwide cohort studies.
Do you change therapy? If they are also on methotrexate, which medication would you potentially stop first?
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...
For example, would it be appropriate to consider JAK inhibitor therapy as preferable to TNF-alpha inhibitor in patients with heart failure with reduce...
Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR
How does a diagnosis of active RA inform your treatment approach for patients with breast cancer, if at all?
Would you change the treatment to rituxan or continue orencia with regular dermatology follow up?
Is there an increased drug induced lupus risk?
What immunosuppression and dosing do you typically use?
Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...
Would you use immunosuppression in patients several years after curative treatment for melanoma?
Would your answer change for favorable vs unfavorable intermediate risk disease?
Does Quantiferon gold replace the need for baseline chest x-ray screen?
The ACR 2021 RA Guidelines suggest the gradual tapering approach is preferable.
Giving "rescue therapy" to patients in the combination group implies that there is room to escalate to the dose at enrollment.
Withdrawal of methotrexate may lead to more disease flares and lack of recoverability with other TNF inhibitors.
Usual clinical practice is to add TNFi once methotrexate monotherapy has failed. If this is the case in these patients, it would seem to increase the ...
Do you switch to SQ MTX, or is it best to add tx, such as a TNFi?
Specifically: starting dose, rapidity of up-titration, frequency of lab monitoring, frequency of office visits, and timing of assessment for treatment...
If so, how would positive levels guide your management?
For example, healthcare workers who require these vaccines for employment
Do you stop methotrexate or adjust the dose?
Does your management change if there is renal involvement of the malignancy?
Reduced requirements for documentation by CMS in 2021 with respect to billing and coding have raised new questions about what aspects of physician exa...
If so, what would be an ideal DMARD in this setting?
Prior therapies include MTX, abatacept, rituximab
If so, would you adjust the dose?
This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspired by the...
Due to the shortage of rheumatologists, primary care physicians may need to manage some rheumatologic issues.
This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet
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Papers discussed in this category
Journal of psoriasis and psoriatic arthritis, 2019-04
Arthritis Rheumatol, 2016 Jan
Clin. Rheumatol., 2017 Aug 18
Archives of internal medicine, 2008-09-22
Arthritis and rheumatism, 2010-06
Arthritis care & research, 2012-05
Eur J Rheumatol, 2017 Feb 23
Rev Bras Reumatol Engl Ed, 2016 Mar 16
Arthritis & rheumatology (Hoboken, N.J.), 2016-11
Annals of the rheumatic diseases, 2019-04
Southern medical journal, 2016-11
Annals of the rheumatic diseases, 2011-05
Atherosclerosis, 2015 Aug 28
Clin Rheumatol, 2012 Nov 22
Ann Pharmacother,
Arthritis Care Res (Hoboken), 2016 Jan
JAMA network open, 2018-11-02
Rheumatol Int, 2020 Sep 18
N Engl J Med,
Mediterr J Rheumatol, 2020 Jun 11
J Rheumatol, 2014 Aug 15
Ann Clin Lab Sci,
Pediatr Rheumatol Online J, 2021 Feb 16
Clin Rheumatol, 2020 Mar 23
Ann Rheum Dis, 2019 Aug 14
Arthritis Rheumatol, 2021 Mar 24
Arthritis Rheum,
JAMA Netw Open, 2021 Feb 01
Rheumatology (Oxford),
Arthritis and rheumatism, 1992-08
Arthritis and rheumatism, 1995-12
Arthritis care & research, 2019-11
Arthritis Care Res (Hoboken), 2019 Dec
Int J Rheum Dis, 2020 Sep 10
J Rheumatol, 2015 Jul 15
Lancet,
Arthritis & rheumatology (Hoboken, N.J.), 2016-01
Ann Intern Med, 2020 Sep 22
Ann Rheum Dis, 2021 May 28
RMD Open,
Arthritis Care Res (Hoboken), 2019 Nov 29
Semin Arthritis Rheum, 2008 Dec 31
Ann Intern Med, 2021 Aug 31
Lancet Oncol., 2013-10-01
Arthritis Care Res (Hoboken), 2021 Jul
Clin Liver Dis (Hoboken), 2018 Aug 22
Ann Rheum Dis, 2016 Oct 03
N Engl J Med,
Arthritis Rheumatol, 2021 Mar 24
BMJ Open, 2014 Aug 14
Int J Rheum Dis, 2018 Sep 05
N Engl J Med, 2003 Feb 13
Metabolites, 2022 Nov 05
J Rheumatol, 2022 Mar 15
Semin Arthritis Rheum, 2020 Jul 02
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2019-08
Transpl Int, 2022 Aug 12
Immunity, 2017-06-20
Autonomic neuroscience : basic & clinical, 2008-12-05
Drug Dev Res, 2014 Nov
Thorax, 1985 May
BMJ, 2023 May 30
BMJ, 2023 May 30
Ann Rheum Dis, 2021 Sep 07
Arthritis research & therapy, 2023 Nov 20
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Clinical rheumatology, 2020 Sep 28
Frontiers in immunology, 2022 Sep 15
Cancer cell, 2022 May 09
Nature communications, 2021 Jun 07
Lancet (London, England), 2023 Feb 24
Lancet (London, England), 2023 Feb 24
The American journal of gastroenterology, 2003 Jun
The Journal of rheumatology, 2015 Jun 15
Medicine, 2014 Oct
Rheumatology (Oxford, England), 2011-12
RMD open, 2022 Nov
British journal of rheumatology, 1992 Nov
Pharmacotherapy, 2002-09
Medicine, 2001 Jul
American journal of respiratory and critical care medicine, 2015 Jul 15
Ann Rheum Dis, 2022 Jan 13
J Immunother Cancer, 2023 Mar
Diagnostics (Basel, Switzerland), 2022 Jul 08
BMC public health, 2008 Jan 21
Rheumatology (Oxford, England), 2021 Nov 03
Arthritis & rheumatology (Hoboken, N.J.), 2017-03
Annals of the rheumatic diseases, 2019 Jul 30
Autoimmunity reviews, 2021 Apr 19
Rheumatology (Oxford, England), 2021 Dec 24
The Lancet. Rheumatology, 2024 Apr 04
Rheumatology (Oxford, England), 2023 Oct 19
JAMA, 2021 May 04
Annals of the rheumatic diseases, 2016 Jul 12
PloS one, 2014
Arthritis care & research, 2017-12
Annals of internal medicine, 2019-06-18
Arthritis care & research, 2022 Jun 19
Clin Rheumatol, 2021 Apr
The Journal of rheumatology, 1997 May
British journal of rheumatology, 1995 May
Annals of the rheumatic diseases, 2016-04
Arthritis research & therapy, 2021 Sep 18
Arthritis and rheumatism, 1988-07
Arthritis and rheumatism, 1993-06
The Journal of rheumatology, 2014 Apr 15
JAMA internal medicine, 2017 Nov 01
Annals of the rheumatic diseases, 2024 Jan 11
Rheumatol Int, 2021 Jan 29