Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
Would you consider a shorter course of Romosozumab (3 months) followed by maintenance therapy given recent evidence that it is noninferior to 12 months of therapy for treatment of severe osteoporosis?
A recent publication led by Leder et al (Lancet Diabetes Endocrinol 2026;14: 216–22) demonstrated that a brief 3-month course of romosozumab followed by denosumab was noninferior to a full 12-month course of romosozumab given in the standard manner. This is consistent with earlier (nonrandomized) ob...
In patients with a history of retinal vein occlusion, how should the risk of recurrent thromboembolic events influence the selection of osteoporosis therapies?
The FDA-approved prescribing information for raloxifene explicitly lists retinal vein thrombosis alongside deep vein thrombosis and pulmonary embolism as contraindications.
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
How do you manage a patient with SLE with acute bilateral sensorineural hearing loss refractory to high dose systemic and intratympanic steroids, normal MRI brain and APL labs?
Interesting, as I just saw a case almost exactly like this one (except my patient was unilateral)! I question whether systemic lupus erythematosus is truly the cause of the hearing loss. If immunologically induced (ie, autoimmune hearing loss), I'd expect to see at least some objective improvement o...
Over what timeline do you typically try to escalate your LN patients to triple therapy?
The new recommendation is "Early Quadruple Therapy" per the 2025 EULAR Lupus Nephritis Guidelines announced during a presentation at EULAR 2025 by Dr. Dimitrios Boumpos.Kudos to EULAR! They recommend this to: increase remission rates reduce the need for steroids with these steroid-sparing agents red...
How do you decide which children need early steroid-sparing therapy rather than hydroxychloroquine plus a short steroid course in pediatric non-renal SLE?
Unfortunately, the majority of our pediatric systemic lupus erythematosus patients have renal disease. Of those who do not, I cannot think of anyone I only treated with hydroxychloroquine after a brief steroid burst. If they have systemic disease, they need a DMARD to spare steroids beyond hydroxych...
Would you avoid use of JAK inhibitors in patients with dermatomyositis with autoantibody subtypes with increased risk of malignancy (TIF1y, NXP2)?
This is a difficult question to answer with certainty. Most of the direct data on malignancy risk with JAK inhibitors come from rheumatoid arthritis studies, and primarily involve tofacitinib. It is therefore possible that the risk is not the same across all JAK inhibitors, especially since they dif...
Do you taper glucocorticoids less aggressively when symptoms improve but serologies remain active in a patient with non-renal SLE?
Cautious tapering of glucocorticoids is a good idea in the setting of ongoing serologic activity. However, given there is clinical improvement in symptoms, one can go ahead and proceed with tapering steroids. It is important to recognize that a subset of patients with SLE may have persistent abnorma...
Which serologic tests are most helpful when evaluating for suspected drug-induced lupus?
If I suspect drug-induced lupus, I typically order the following laboratory testing: ANA/IFA Anti-histone antibody, usually positive in drug-induced lupus Anti-Ro antibody, usually positive in drug-induced subacute cutaneous lupus Anti-dsDNA, usually negative in drug-induced lupus vs positive in id...
Do you always perform salivary gland biopsy to confirm the diagnosis In patients with suspected seronegative Sjogren's syndrome?
I often struggle with the decision of obtaining a biopsy in suspected Sjogren's in a person who is seronegative, when the main issue is dryness, and the main reason is that I wonder if it will make a difference in management. When I was a Rheumatology fellow, I was taught to give Hydroxychloroquine ...