Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
Do you stop TNF inhibitors during the third trimester of pregnancy?
TNF inhibitor use in pregnancy is a common topic I review with patients. I make sure I include family members in my medication safety talks as well as provide tangible information, because unfortunately in the US there is a harmful stereotype that medications taken in pregnancy are bad and pregnant ...
How would you approach management of a patient with ankylosing spondylitis who was doing well on tofacitinib, but experienced a STEMI while on therapy?
This is an excellent question and complex clinical scenario. The patient is HLA-B27 positive with sacroiliitis, peripheral arthritis, and uveitis, and has previously failed two TNF inhibitors but experienced STEMI while on JAKi.We have the option to switch to IL-17i but we know IL-17- do not prevent...
How do you approach “clearing” a patient with SLE and ESRD for renal transplant?
Prefer the term "optimizing" as opposed to "clearing" SLE patients for procedures such as renal transplants and issues here similar to identifying the preferred time to proceed with pregnancy, specifically in patients with a history of LN, with the goal in both scenarios of achieving desired outcome...
How would you manage autoimmune pancreatitis in a patient after Whipple's procedure?
There are two types of autoimmune pancreatitis (AIP): type 1 AIP, which is synonymous with IgG4-related disease (IgG4-RD) involving the pancreas and makes up a large majority of AIP cases, and type 2 AIP, which is largely associated with inflammatory bowel disease. I am assuming from the question th...
Is there a benefit to having a transition period in which a patient continues following with their previous pediatric rheumatologist while establishing care with a new adult rheumatologist?
Several pediatric to adult care models exist. Some models involve transition clinics in which adult and pediatric providers are both present and care may overlap between the two providers. Others are primarily focused on the pediatric side in preparing adolescents and young adults for care in the ad...
What is typical presentation and time course for belimumab infusion-related depression and/or hallucinations, and how do you approach management?
As the reported occurrence of severe depression AEs is rare (<0.5%), one can not really ascribe a 'typical' presentation to depression occurring in the context of treatment with belimumab infusions. The reasons/mechanisms underlying the consistently observed increased incidence of this AE in both th...
Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?
Familial HLH (fHLH) is a pediatric disease. Therefore, there is no place for genetic testing to establish a diagnosis of fHLH in adults, and treatment for HLH should not be delayed while waiting for genetic testing. However, there are hypomorphic polymorphisms in the fHLH genes that may be a contrib...
Do you always get a baseline chest xray in patients who will be starting methotrexate?
I believe it is a good practice for screening CXR before Mtx to document baseline findings, which will help to register if there is some baseline issues.
What is your approach to screening for malignancy in dermatomyositis patients who do not have a high risk antibody profile and whose disease responds well to treatment?
This is a great question and one that is very relevant to our clinical practice. Different myositis specific and associated antibodies seem to carry different risks in their associations with cancer. My colleague, Dr. Alexander Oldroyd, has written our current guidelines on cancer screening for pati...
In light of recent measles outbreaks, have you adjusted your vaccination counseling or preventive strategies for adult immunocompromised patients?
Check measles antibody (once) in individuals working in public places, especially when working with kids.