How do you approach immunosuppression in patients with rheumatoid arthritis and newly diagnosed bladder cancer who willl be starting intravesical BCG therapy?   

I would hold at the time that intravesical BCG is decided upon to maximize the potential efficacy of the BCG therapy. As for when to restart, it depends on how the patient is doing from an RA standpoint and what medication they were on. It is probably good to wait at least two weeks to restart after...