Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
Is there evidence that either ASDAS or BASDAI is superior for measuring clinical outcomes in axial spondyloarthritis?
BASDAI and ASDAS are validated measures of AS disease activity and are used simultaneously in clinical trials. BASDAI (Bath Ankylosing Spondylitis Disease Activity Index)1 exhibits good reliability, sensitivity to change in response to intervention, has 6 questions (fatigue, back pain/hip pain, peri...
Is a comprehensive physical exam with vital signs warranted for routine follow-up visits in well-controlled uncomplicated RA patients?
This is an important question for which we don't have an evidence-based answer yet, but it is likely that our practice will change with these new guidelines, and with the expansion of telemedicine. I think we cannot have a one size fits all recommendation. Many factors may influence the need for a f...
Is there a role for measuring hydroxychloroquine blood levels in clinical practice?
This is being actively investigated by a number of groups around the world, with no final consensus, but the groups in France have studied this the longest, and published the most, to date. The major outcome has been that some (quite a few) patients had very low levels, who admitted on careful quest...
Would you use an IL-17 inhibitor for a psoriatic arthritis patient with inactive inflammatory bowel disease?
It depends on the options. While I would generally avoid using an IL-17 inhibitor in a patient with a h/o IBD, if there are no other reasonable treatment alternatives, and the IBD has been inactive for a significant period of time (a year?), then I would consider it, after a full discussion of the r...
How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?
In general, a history of splenectomy would lead to an increased concern regarding infections with parasitemia and encapsulated organisms (particularly Strep. pneumoniae, Haemophilus influenzae type b, and Neisseria meningitides). However, I would not consider prior splenectomy an absolute contraindi...
Is nailfold capillaroscopy useful for prognostication and evaluation of disease progression in scleroderma patients?
Nailfold capillaroscopy is most commonly used for diagnostic purposes in patients with Raynaud's phenomenon (RP), but is also useful for prognostication and evaluation of disease progression in systemic sclerosis (SSc) patients.Nailfold capillaroscopy examines the terminal row of capillaries at the ...
Is nailfold capillaroscopy useful for prognostication and evaluation of disease progression in MCTD/myositis patients?
Great question for clinicians: Nailfold capillaroscopy is useful for several systemic autoimmune diseases and, not surprisingly, multiple studies have documented frequent nailfold capillary abnormalities in patients with multiple types of autoimmune myositis, including dermatomyositis (DM), anti-syn...
How do you approach a patient found to have a coronary lesion suggestive of vasculitis on coronary CT?
I am not sure what findings are considered “suggestive of vasculitis on coronary CT”. Vasculitis in the coronary arteries is quite rare but can be seen in several vasculitides. There is a big difference in seeing angiographic changes atypical for atherosclerosis (which I assume is what is meant by t...
What is the biologic of choice in a patient with RA and myasthenia gravis?
There is no biologic of choice for patients with Myasthenia Gravis (MG). Given the disease's rarity, the data is scant. A prospective pilot trial of etanercept in 11 patients with corticosteroid-dependent observed that 6 of the 8 patients who completed the trial improved, based on quantitative measu...
How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?
Due to the rarity of CAPS, there are no evidence-based guidelines available and most treatment is empiric or based on expert guidance. Most would agree that the mainstay of treatment is anticoagulation, and the preferred anticoagulant is unfractionated heparin. In a recent guideline paper, therapeut...