What is your approach to managing RA patients with history of organ transplant already on immunosuppressive therapy such as cyclosporine or cellcept?

In contrast to my esteemed colleague, @Dr. First Last, in 38+ years in clinical rheumatology practice (maybe those 3 years make a difference), I have seen RA occur in 3 patients with solid organ transplants. All 3 were renal transplants; all 3 were recurrent diseases that had been previously control...

I would also agree with the strong consideration of CTLA-4 inhibitor, as Dr. @Dr. First Last mentioned.

For what it is worth, several case reports/series have shown the benefit of Abatacept as "rescue therapy" in kidney transplant patients (such as Uro-Coste et al., PMID 36033643, and Badell et al., ...

In 35+ years, I have never seen this so I expect it is quite rare. When confronted with allogeneic marrow transplants, rituximab was effective (Bettag et al., PMID 32911283). Probably worth a chat with your transplant colleagues.

William Rigby

I think if the patient has active Rheumatoid Arthritis, one would have to look closely at the transplant regimen of meds.