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Topics:
Rheumatology
•
Vasculitis
How would you approach a patient with EGPA, with main manifestations of asthma, nasal polyposis, and mononeuritis multiplex, who has clinically responded to rituximab, yet has persistently high eosinophilia (>40%)?
Would you add mepolizumab for the eosinophilia?
Related Questions
How long do you continue rituximab in patients with ANCA associated vasculitis who have achieved remission?
Would you consider switching to benralizumab for patients with EGPA experiencing severe pulmonary symptoms despite being on mepolizumab?
How would you approach the treatment for patients with renal-limited ANCA vasculitis who have persistent proteinuria, hematuria, and ANCA titers and have completed a steroid taper and received three doses of rituximab?
How would you approach failure of maintenance therapy (Azathioprine) for PR3 positive, c-ANCA positive, pulmonary–renal vasculitis previously induced with cyclophosphamide, with a history of anaphylaxis to rituximab?
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (eg cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (eg neuropathy, palpable purpura, or glomerulonephritis)?
How do you approach tapering of tocilizumab used for a history of GCA with vision loss?
How soon after starting treatment for Takayasu arteritis do you decide on the need for any vascular interventions to manage chronic damage?
How would you approach a male in his 60s with bilateral optic perineuritis/neuritis on MRI, steroid-responsive bilateral jaw pain, normal ESR/CRP, negative temporal artery biopsy, and elevated IgG4?
Do you consider immunosuppression in a patient with cocaine-induced midline lesions who is ANCA positive, but has no other evidence of vasculitis?
What options are available for patients who require high dose steroids while taking strong CYP4A4 inducers?