Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
Is there a maximum duration for raloxifene use?
There is relatively scant data on long-term raloxifene use in patients with osteoporosis, but generally, there are no recommendations for a drug holiday. The primary endpoint in the pivotal registration trial, MORE, was incidence of vertebral fracture, and the difference between the raloxifene and p...
How do you approach the significance of +RNP III antibody in a patient with positive ANA but no other signs or symptoms of systemic sclerosis?
RNA polymerase III is a specific autoantibody for a subset of systemic sclerosis associated with severe diffuse cutaneous scleroderma, renal crisis, GAVE, and a strong association with malignancy. If this antibody is identified in the absence of Raynaud's or other symptoms of scleroderma, its signif...
How do you manage episodes of Raynaud's that are frequent and bothersome in the winter months?
If Calcium channel blockers (Nifedipine extended release, Amlodipine) have been trialed already, and non-pharmacological management [including avoiding cold exposure, stress, and certain vasoconstrictive medications (e.g., beta-blockers, nasal decongestants, amphetamines, migraine drugs)] has been m...
How should rheumatologists address the impact on patients who are initially diagnosed with SLE based on positive ANA, but later reclassified as having UCTD?
I experience this question a bit differently. Patients who are told they have a diagnosis are frequently living in a certain mindset with a certain expectation and possibly even a fear of the alteration of their life. The patient with a diagnosis trusted a doctor to give them sound and honest advice...
What is the recommended timing for starting denosumab after completing zoledronic acid?
6 months
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How would you manage active severe psoriasis in a patient planning pregnancy, who also has psoriatic arthritis with well-controlled joint symptoms on certolizumab pegol (anti-TNF therapy)?
If the psoriasis was sufficiently limited in area that topicals were a practical solution, I'd first try to assure that the prescribed topical steroids were being used well. Poor adherence is a common issue with topical treatment. Phototherapy might be my next choice. I feel comfortable prescribing ...
Do you check IgA levels before starting IVIG for other autoimmune conditions?
Whereas it is not mandatory to check IgA levels before starting IVIG, it is prudent to do so in non-urgent situations since the patients with IgA deficiency, especially those who have developed anti-IgA antibodies, are at an increased risk of severe hypersensitivity or anaphylactic reactions from IV...
Are there any successful disease modifying therapy for diffuse idiopathic skeletal hyperostosis (DISH)?
Therapy for DISH is largely supportive: PT, NSAIDs/pain relievers, and control of contributing metabolic conditions, nutrition, exercise, and lifestyle changes; when necessary surgical interventions such as surgical resection of osteophytes and spinal fusion are required.Clinical research in DISH is...
How do you approach DMARD therapy in a patient with lupus and recurrent pericarditis?
Both asymptomatic pericardial effusions and symptomatic pericarditis are common in systemic lupus erythematosus (SLE) patients. I will limit my answer to symptomatic pericarditis per the question.The first thing to be sure of is that the symptoms are truly due to pericarditis. The full differential ...