Questions discussed in this category

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

Would you consider keeping the patient on denosumab or would switch to an anabolic agent?

Specifically in patients of Vietnamese background? An association has been shown between HLA-B*5801 and the risk of allopurinol hypersensitivity react...

Especially given the recent FDA approval of voclosporin, how should we think about the use of this medication for LN? 

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

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

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?

Does Quantiferon gold replace the need for baseline chest x-ray screen? 

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 ...

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

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?

Myositis specific antibodies and pathology results often take weeks to result.  In which cases do you start therapy before the diagnosis is solid...

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

Would you change the treatment to rituxan or continue orencia with regular dermatology follow up?

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

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

While low-dose aspirin for primary thrombosis prevention in aPL without APS is not typically recommended outside cardiovascular prevention guidelines ...

What factors go into choosing the right patient and determining length of therapy?

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect? 

Do you avoid due to the increased risk of GI adverse events?

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

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

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

Specifically: starting dose, rapidity of up-titration, frequency of lab monitoring, frequency of office visits, and timing of assessment for treatment...

E.g., inflammatory polyarthritis or inflammatory myopathy with onset within 2 weeks of documented COVID infection

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

Does denosumab effect knee replacement or hip replacement? Should replacement occur right before or after injection? 

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

How would you label such a patient?  Would you treat differently if they have poor functional status?

Patient was previously well controlled on methotrexate, which was discontinued during cancer treatment.

Cyclophosphamide/tacrolimus and Rituximab have been used in conjunction with steroids in case series.

Current guidelines do not support its use, but the EMPACTA trial suggests it may be effective in a subpopulation of patients.

If so, are there specific patient populations for which you would use this metric?

Reduced requirements for documentation by CMS in 2021 with respect to billing and coding have raised new questions about what aspects of physician exa...

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

How do you counsel these patients about hormonal agents? 

Due to the shortage of rheumatologists, primary care physicians may need to manage some rheumatologic issues.

The SENSCIS trial was published in 2019 on efficacy of this agent. However, it's not clear where this should be in the treatment algorithm: Monot...

In a patient with early stage breast cancer that would otherwise require radiation, would you recommend treatment if the patient has active skin lupus...

Also, how would you handle immune modulators for rheumatoid arthritis during their treatment?

Do you re-challenge with nivolumab alone, change from nivo 1/ipi 3 to nivo 3/ipi 1 upon re-challenge, or stop immunotherapy altogether if grade 3?&nbs...

How about those with metastatic disease eager to maintain quality of life? Do you risk progression of disease if the TNF blocker is re-started?

Would you require the rituxan to be held prior to radiation?  Would this matter if it was in the post-prostatectomy setting?

Are there any other medications, outside of anticoagulation, that would be considered absolute or relative contraindications?

Do you always stick with a conventional fracionation, or in some cases, are you comfortable hypofractionating? Do you ever use a wait and see approach...

Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?

Do you have any concern for increased toxicity when you treat a patient with radiation therapy who has an autoimmune disorder? (hypofractiationation v...

Papers discussed in this category

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1997-07

Brachytherapy, 2011

Brachytherapy, 2011

JAMA Netw Open, 2021 Feb 01

Annals of internal medicine, 2018-01-16

Radiation oncology (London, England), 2012-02-16

Radiographics : a review publication of the Radiological Society of North America, Inc, 2004

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-03

The New England journal of medicine, 2015-07-16

Expert Opin Drug Saf,


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-10

J Immunother Cancer, 2019 Aug 22

Journal for immunotherapy of cancer, 2017-11-21

Cancer management and research, 2017

Lancet Oncol., 2020 Mar 03

Lancet, 2020 Feb 07

The New England journal of medicine, 2010-07-15

Medicine (Baltimore),

The New England journal of medicine, 2010-07-15

Annals of the rheumatic diseases, 2017-08

Lancet (London, England), 2018-12-01

Arthritis Rheumatol, 2019 Oct

Lancet, 2019 Nov 12

Cochrane Database Syst Rev, 2014 Oct 23


, 2016 Aug 30

RMD open, 2015

The New England journal of medicine, 2018-01-04

Arthritis and rheumatism, 2012-04

Ann Rheum Dis, 2013 Jun 05

Arthritis Rheumatol, 2019 Jan

Ann. Rheum. Dis., 2019 Sep 28


Journal of psoriasis and psoriatic arthritis, 2019-04

Arthritis and rheumatism, 2005-09

Arthritis & rheumatology (Hoboken, N.J.), 2015-05


Best Pract Res Clin Obstet Gynaecol, 2019 Nov 13

Semin. Arthritis Rheum., 2020 Mar 19

Arthritis Rheumatol, 2016 Jan

Arthritis Rheumatol, 2017 Aug

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

The Lancet. Respiratory medicine, 2016-09

The New England journal of medicine, 2006-06-22

The journal of pain : official journal of the American Pain Society, 2019-06

Arthritis care & research, 2019-03

J. Rheumatol.,

Current opinion in rheumatology, 2015-05

Am J Med, 2012 Nov 20

Clin J Pain,

Arthritis & rheumatology (Hoboken, N.J.), 2016-05

Rheumatology (Oxford),

Rheumatology (Oxford),

Clin. Exp. Rheumatol., 2016 Dec 13

Lancet, 2015 Oct 01

J Rheumatol Suppl,

Nat Rev Rheumatol,

Rheumatology (Oxford),

Ann Rheum Dis, 2015 Dec 07

J. Am. Coll. Cardiol.,

Annals of the rheumatic diseases, 1999-04

Arthritis Care Res (Hoboken),

Pain, 2020 May 18

J. Rheumatol., 2019 Jan 15

Arthritis and rheumatism, 1982-11

Arthritis and rheumatism, 2012-08

, 2019 Aug 06

Arthritis Rheum.,

Rheumatology (Oxford), 2020 Feb 11

Multiple sclerosis (Houndmills, Basingstoke, England), 2014-01

Ann. Neurol., 2018 Feb 15


Clin. Rheumatol., 2017 Aug 18

Archives of internal medicine, 2008-09-22

Arthritis and rheumatism, 2010-06

Arthritis Care Res (Hoboken), 2017 Aug

Ann. Rheum. Dis., 2018 Apr 25

Ann. Rheum. Dis., 2017 May 25

Ann. Rheum. Dis., 2018 May 03

J Med Imaging Radiat Oncol,

J Ultrason, 2016 Mar 29

Neurology, 2016 Nov 16

Clin. Chest Med., 2015 Sep 26

Clin. Exp. Rheumatol., 2013 Dec 09

Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2016-04

Blood, 2018 Jul 12

Ann. Intern. Med., 2019 Oct 15

Arthritis care & research, 2012-05

Medicine, 1976-05

Ann. Rheum. Dis., 2019 Sep 20

Arthritis and rheumatism, 2010-01

J. Rheumatol., 2019 Sep 01

Ophthalmology, 2015-05


Ophthalmic Res, 2018 Apr 10

Dev Ophthalmol, 2012 Apr 17

Arthritis Rheumatol, 2019 Aug 12

American journal of ophthalmology, 2017-11

JAMA, 2006-12-27

Annals of the rheumatic diseases, 2019-10


Arthritis care & research, 2017-03

Clin Exp Dermatol, 2018 May 24

Journal of spinal disorders, 2001-10

Arthritis Rheum,

N Engl J Med,

Annals of the rheumatic diseases, 2009-03

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

BJR Case Rep, 2018 Sep 08

Southern medical journal, 2016-11

Annals of the rheumatic diseases, 2011-05

Atherosclerosis, 2015 Aug 28

Ann Intern Med, 2020 Sep 22

Clinical immunology (Orlando, Fla.), 2019-09

Seminars in arthritis and rheumatism, 2019-08

Clin Rheumatol, 2012 Nov 22

Ann Pharmacother,

Curr Rheumatol Rep, 2020 Oct 16

Arthritis Care Res (Hoboken), 2016 Jan

Osteoarthritis Cartilage, 2018 Mar 02

Ann Rheum Dis, 2018 Oct 03

Ann Rheum Dis, 2018 Dec 14

Lancet, 2019 Nov 11

JAMA ophthalmology, 2014-12

Can J Ophthalmol,

J Am Acad Dermatol, 2016 Feb 03

N Engl J Med,

Lancet, 2016 Mar 04

N Engl J Med, 2020 Apr 29

JAMA network open, 2018-11-02

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2008-10

Clin Rheumatol, 2006 Dec 21

Blood, 2015 May 13

Blood, 2009 Nov 06

Rheumatol Int, 2020 Sep 18

The Journal of rheumatology, 2009-12

Semin Arthritis Rheum, 2020 Jun

Intern Med, 2014 Dec 01

J Am Heart Assoc, 2019 Sep 06

Clin Rheumatol, 2007 Mar 30

Annals of the rheumatic diseases, 2017-04

Arthritis Care Res (Hoboken), 2018 Aug

Arthritis Care Res (Hoboken),

Curr Rheumatol Rep,

Ann Rheum Dis, 2011 Jul 28

The Journal of arthroplasty, 2008-02

Ann Rheum Dis,

The journal of allergy and clinical immunology. In practice, 2017

J Am Dent Assoc,

Arthritis Rheumatol, 2016 Oct 26

Ann Rheum Dis, 2019 Oct 31

Annals of the rheumatic diseases, 2011-10

Arthritis Rheum,

J Rheumatol,

Ann Rheum Dis, 2008 Jul 14

Ann Rheum Dis, 2010 Nov 10

N Engl J Med,

Mediterr J Rheumatol, 2020 Jun 11

Autoimmun Rev, 2019 Sep 11

Clin Exp Rheumatol, 2020 Aug 26

Microvasc Res, 2016 Sep 07

J Rheumatol, 2019 Aug 15

Journal of thrombosis and haemostasis : JTH, 2018-06-07

Clin Infect Dis,

The New England journal of medicine, 2017-05-18

Kidney international reports, 2018-03

N Engl J Med, 2020 Feb 13

Rheumatology (Oxford),

Rheumatol Int, 2019 Apr 30

Clin Exp Rheumatol, 2012 Sep 25

Wien Klin Wochenschr,

N Engl J Med, 2020 Dec 10

N Engl J Med, 2020 Dec 17

Front Pharmacol, 2019 Mar 26

Kidney international, 2019-01

J Rheumatol, 2006 Jul 01

Semin Arthritis Rheum,

Lancet Respir Med, 2020 Aug 28

Rheumatology (Oxford), 2013 Feb 16

Ann Rheum Dis, 2005 Jan 13

Ann Rheum Dis, 2016 Jan 14

Ann Rheum Dis, 2014 Jan 22

Ann Rheum Dis, 2012 May 14

Ann Rheum Dis, 2015 Aug 18

N Engl J Med,

Lupus, 2008-08

Arthritis Rheumatol, 2021 Aug 12

The Journal of rheumatology, 2012-02

J Rheumatol, 2014 Aug 15

Ann Clin Lab Sci,

Pediatr Rheumatol Online J, 2021 Feb 16

Clin Rheumatol, 2020 Mar 23

The American journal of medicine, 1984-01

Arthritis Rheum,

Ann Rheum Dis, 2019 Aug 14

Rheumatology (Oxford, England), 2011-12

Nat Rev Neurol,

Nat Rev Dis Primers, 2018 Aug 02

Nature reviews. Rheumatology, 2018-05

Trials, 2017 Jun 15

N Engl J Med, 2019 Sep 29

Arthritis Rheumatol, 2021 Feb 03

Best Pract Res Clin Rheumatol,

N Engl J Med, 2021 Feb 18

Rheumatology (Oxford), 2021 Jan 07

Clinical and experimental rheumatology, 2018

Cochrane Database Syst Rev, 2013 May 31

Arthritis Rheumatol, 2020 May

Int J Clin Pract, 2021 Mar 24

Mod Rheumatol, 2021 Feb 09

Heart Rhythm, 2020 Jun 28

N Engl J Med, 2012 May 20

Ann Rheum Dis,

Lancet Rheumatol, 2021 Apr 06

N Engl J Med, 2020 Nov 20

Rheumatology (Oxford),

Semin Arthritis Rheum,

Ann Rheum Dis, 2017 Mar 23

The Journal of rheumatology, 2004-12

Clin Pharmacokinet,



Annals of the rheumatic diseases, 2009-06

Arthritis Care Res (Hoboken), 2019 Oct

J Clin Rheumatol, 2021 Sep 23

The New England journal of medicine, 2015-10-22

Rheumatol Int, 2019 Feb 18

Arthritis and rheumatism, 2001-12

Arthritis care & research, 2018-03

J Clin Rheumatol, 2020 Sep 18

Cureus, 2020 Aug 02

Gut, 1999-04

Gut, 2012-12

Annals of the rheumatic diseases, 2019-04

Ann Rheum Dis, 2014 Mar 21

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

Lupus, 2007

J Allergy Clin Immunol, 2020 May 22

Nat Rev Rheumatol,

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

Ann Intern Med,

Ann Rheum Dis, 2011 Nov 29

Trends Mol Med, 2021 Jun 07

Rheumatology (Oxford),

Rheumatology (Oxford), 2019 Mar 05

Arthritis & rheumatology (Hoboken, N.J.), 2015-07

Arthritis Rheum,

Lancet, 2021 May 07

Ann Rheum Dis, 2016 Nov 09

Arthritis Rheumatol, 2021 Mar 24

Respir Med, 2012 Apr 09

Am J Respir Crit Care Med,

Arthritis Rheum,

Autoimmunity reviews, 2009-02

Arthritis and rheumatism, 2013-07

Arthritis Rheumatol, 2021 Mar 24

Rev Med Interne, 2016 Oct 13

Arthritis Care Res (Hoboken), 2021 Mar 30

JAMA Dermatol,

Mod Rheumatol, 2020 Sep 17

Ann Rheum Dis, 2014 Feb 13

Ann Rheum Dis, 2019 Jan 04

Ann Rheum Dis, 2014 Apr 16

Seminars in arthritis and rheumatism, 2010-12

Clin Exp Rheumatol, 2012 Oct 17

Inflamm Bowel Dis,

Am J Clin Dermatol,

Arthritis Rheum,

Eur Heart J, 2015 Aug 29

Eur Respir J, 2019 Jan 24

Arthritis Rheumatol, 2017 May

Arthritis Rheumatol, 2021 May 24

N Engl J Med, 2021 Aug 04

Annals of internal medicine, 1994-06-15

Front Neurol, 2019 Jun 06

Journal of the American Society of Nephrology : JASN, 1993-07

Arthritis and rheumatism, 2013-02

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2014-02

Lupus, 2018-03


Arthritis Rheum,

Rheumatology (Oxford), 2021 May 18

Am J Transplant, 2013 Jun 13

Curr Opin Rheumatol,

Arthritis Rheum,

Rheumatology (Oxford),

BMJ Open, 2019 May 05

Rheumatol Int, 2021 Jan 29

Best practice & research. Clinical anaesthesiology, 2014-06

The Journal of rheumatology, 2016-08

JCI Insight, 2021 Feb 08

Arthritis Rheumatol, 2021 Jun 01

Adv Ther, 2018 Mar 20

J Arthroplasty, 2017 Jun 19

Int J Mol Sci, 2020 Mar 04

Open Access Rheumatol, 2019 Jan 29

Respirology, 2016 Dec 17

Thromb Res, 2021 Jun 25

The New England journal of medicine, 2018-03-29

Seminars in arthritis and rheumatism, 2012-06

Arthritis Rheumatol, 2021 Jul 08

Ann Rheum Dis, 2019 Jul 03

Arthritis and rheumatism, 1992-08

Arthritis and rheumatism, 1995-12

Radiographics : a review publication of the Radiological Society of North America, Inc, 2001

International journal of clinical rheumatology, 2010

Rheumatology (Oxford),

Z Rheumatol,

Lupus, 2013-07

Arthritis care & research, 2019-07

Arthritis care & research, 2019-11

J Rheumatol,

Lupus Sci Med, 2018 May 14

Lupus Sci Med,

Lupus, 2015 Jul 10

Mayo Clin Proc,

Lancet Haematol,

Journal of neurovirology, 2018-06

Lupus science & medicine, 2014

The Journal of rheumatology, 2015-11

Ophthalmology, 2016-06

Lupus science & medicine, 2017

Journal of immunology research, 2017

Lupus science & medicine, 2018

Clin Pharmacol Ther, 2018 Jun

Lupus Sci Med, 2016

Lupus Sci Med, 2016 Feb 01

Lupus Sci Med,

ACR Open Rheumatol, 2020 Oct 12

Arthritis Rheumatol, 2021 May 02

Ann Rheum Dis, 2012 Nov 10

Arthritis Rheum,


Arthritis Rheumatol, 2020 Jan 07

Lancet (London, England), 2015-09-19

Brain : a journal of neurology, 2016-05

Scand J Rheumatol, 2018 May 18

Lupus Sci Med, 2019

Arthritis care & research, 2019-11

Arthritis Care Res (Hoboken), 2019 Dec

Int J Rheum Dis, 2020 Sep 10

J Rheumatol, 2015 Jul 15

Arthritis care & research, 2018-10

Seminars in respiratory and critical care medicine, 2002-12

Clinics in liver disease, 2019-05

Eur J Gastroenterol Hepatol,

Neth J Med,

Semin Respir Crit Care Med, 2020 Aug 10

J Rheumatol, 2019 Apr 01

RMD Open,

Seminars in arthritis and rheumatism, 2016-02

Bull Soc Ophtalmol Fr,

Ann Rheum Dis, 2021 Jul 02