Vasculitis   

Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis? 

The patient has ongoing inflammatory arthritis despite methotrexate, apremilast, and jak inhibitor trials.

Would you be comfortable combining a TNFi with Rituxan in this patient? 

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

Would you change rituximab maintenance dose or schedule?

ADVOCATE trial

In the ADVOCATE trial, patients were not re-dosed with rituximab.

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

 If you use both, how do you decide which to use for a particular patient?