General Internal Medicine

Rheumatoid Arthritis

Questions discussed in this category

How would you approach management of a patient with seropositive RA and UIP-ILD, with concern for active lung disease?

Joint symptoms are stable on Hydroxychloroquine. Is there benefit of adding methotrexate or Rituximab for lung disease? CT of chest with predominately...

1 Answer available

How do you screen rheumatoid arthritis patients for lung disease (modality, frequency, patient selection)?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspired by the...

5 Answers available

Is it ever safe to use a biologic DMARD in a patient with RA who is on suppressive antibiotics due to a history of septic prosthetic arthritis?

2 Answers available

What is your approach to differentiating RA-ILD from medication toxicity (I.e. from methotrexate)?

1 Answer available

How do you approach use of DMARDs and/or biologics for inflammatory arthritis in patients with a history of seizure disorder on anti-epileptic medications?

Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?

1 Answer available

How would you approach a patient with anti-scl70 ab positive sine scleroderma complicated by ILD who also has seropositive RA with active arthritis?

Arthritis did not respond to HCQ.

2 Answers available

When would you consider utilizing bone scintigraphy in the assessment of inflammatory arthritis?

2 Answers available

Do you use the peri-operative management of biologics and DMARDs guidelines, which were mainly based on total hip and knee replacement surgeries, for all peri-operative surgical management?

Are there certain surgeries (including orthopedic) that you recommend continuing biologic DMARDs?

1 Answer available

How do you approach restarting cDMARDS/bDMARDS in a patient with active RA after incidence of disseminated CNS VZV infection while on tofacitinib?

1 Answer available

How do you approach treatment of a patient with active RA and a history of Lynch Syndrome?

Does your choice of DMARD/biologics change due to increased risk of malignancy?

1 Answer available

Do you consider Anti-carbamylated protein antibodies (anti-CarP) as having any significance in evaluation of patients if RF and ACPA negative and clinically no active synovitis yet widespread arthralgias and generalized osteoarthritis?

1 Answer available

How do you approach patients with RA and severe bronchiectasis with associated findings of UIP?

1 Answer available

Do you typically adjust or hold immunosuppression in a well-controlled RA patient who is being treated for Mycobacterium avium-intracellulare (MAI)?

1 Answer available

How do you approach the timing of DMARD initiation in patients with active RA who are on treatment for latent TB?

Is it different between DMARDs (csDMARDs, biologic DMARDs, and target synthetic DMARDs)?

1 Answer available

How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?

2 Answers available

What is your approach for an RA patient with lung cancer who is starting immunotherapy?

1 Answer available

How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?

Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?

1 Answer available

How would you approach treating a patient with Rheumatoid arthritis/Psoriatic arthritis and alcoholic cirrhosis?

1 Answer available

What would be your approach to a patient with new diagnosis of seropositive rheumatoid arthritis manifesting as a constrictive pericarditis with no joint pain complaints?

Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?

1 Answer available

Have you seen rheumatoid nodules or RA-ILD in patients with seronegative RA?

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

2 Answers available

What is your initial treatment of choice in patients with RA and associated interstitial lung disease?

1 Answer available

How would you treat active rheumatoid arthritis in a patient in complete response on loralatinib for stage IV ALK positive NSCLC?

Patient already on methotrexate and plaquenil.

1 Answer available

Is there utility of modifying DMARD treatment in a seropositive rheumatoid arthritis patient with recurrent pleural effusions and RA nodules without other signs of active disease?

2 Answers available

Do you continue to utilize ESR and CRP in patients on tocilizumab?

2 Answers available

How would you approach treating a patient with active rheumatoid arthritis and a history of treated lymphoma that is currently in remission?

Given the controversy in the literature regarding TNFi or MTX associated lymphoma in patients with RA.

1 Answer available

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

4 Answers available

How do you approach RA management in a patient who develops a new solid tumor while on therapy?

2 Answers available

What is your approach in a patient who develops interstitial lung disease while on anti-TNF therapy?

Do you change therapy? If they are also on methotrexate, which medication would you potentially stop first?

1 Answer available

How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?

Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR

2 Answers available

Do you find 14.3.3 eta or vectra DA helpful in clinical practice?

1 Answer available

What immunosuppressive agents would be available to patients with a history of melanoma?

Would you use immunosuppression in patients several years after curative treatment for melanoma?

1 Answer available

Do you routinely obtain a chest x-ray prior to initiating anti-TNF or other biologic therapy?

Does Quantiferon gold replace the need for baseline chest x-ray screen?

1 Answer available

What was the rationale for abrupt discontinuation of etanercept rather than gradual tapering in the SEAM-RA trial?

The ACR 2021 RA Guidelines suggest the gradual tapering approach is preferable.

2 Answers available

What are your thoughts on use of 14-3-3 serum levels in rheumatoid arthritis in conjunction with RF and ACPA?

1 Answer available

What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?

1 Answer available

How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?

1 Answer available

Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?

If so, how would positive levels guide your management?

3 Answers available

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

1 Answer available

Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?

1 Answer available

How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?

1 Answer available

How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?

2 Answers available

What is your inflammatory arthritis differential when a patient presents with unilateral TMJ synovitis?

2 Answers available

What is your work up and management for patients who develop neuropathy on a TNF inhibitor?

1 Answer available

Do you have any suggestions about how to improve rheumatology training in internal medicine residency programs?

Due to the shortage of rheumatologists, primary care physicians may need to manage some rheumatologic issues.

1 Answer available

How do you manage patients who are Hepatitis B core antibody positive/surface antigen negative and starting a biologic DMARD (other than rituximab)?

1 Answer available

Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?

1 Answer available

Would you re-challenge patients who have had a TNF-associated paradoxical adverse event (such as inflammatory bowel disease) with a different TNF inhibitor?

1 Answer available

Papers discussed in this category

Autoimmunity reviews, 2021 Apr 19

Efficacy and safety of abatacept in interstitial lung disease of rheumatoid arthritis: A systematic literature review.

Arthritis & rheumatology (Hoboken, N.J.), 2024 Jul 08

2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases.

Rheumatology international, 2023 Apr 18

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis.

Autoimmunity reviews, 2024 Sep 11

Janus kinase inhibitors in rheumatoid arthritis-associated interstitial lung disease: A systematic review and meta-analysis.

Journal of psoriasis and psoriatic arthritis, 2019-04

TNF Inhibitor-Induced Psoriasis: Proposed Algorithm for Treatment and Management.

Arthritis Rheumatol, 2016 Jan

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Eur J Rheumatol, 2017 Feb 23

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures.

Rev Bras Reumatol Engl Ed, 2016 Mar 16

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

JAMA network open, 2018-11-02

Association of Immunoglobulin Levels, Infectious Risk, and Mortality With Rituximab and Hypogammaglobulinemia.

Rheumatol Int, 2020 Sep 18

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study.

N Engl J Med,

Clinical practice. Care of the asplenic patient.

Mediterr J Rheumatol, 2020 Jun 11

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies.

J Rheumatol, 2014 Aug 15

Serum 14-3-3η is a novel marker that complements current serological measurements to enhance detection of patients with rheumatoid arthritis.

Ann Clin Lab Sci,

Serum 14-3-3η Could Improve the Diagnostic Rate of Rheumatoid Arthritis and Correlates to Disease Activity.

Pediatr Rheumatol Online J, 2021 Feb 16

Prevalence and significance of serum 14-3-3η in juvenile idiopathic arthritis.

Clin Rheumatol, 2020 Mar 23

Serum 14-3-3η protein is associated with clinical and serologic features of Sjögren's syndrome in patients with systemic lupus erythematosus: a cross-sectional analysis.

Arthritis Rheumatol, 2021 Mar 24

Etanercept or Methotrexate Withdrawal in Rheumatoid Arthritis Patients in Sustained Remission.

Arthritis care & research, 2019-11

Correlation of the Multi-Biomarker Disease Activity Score With Rheumatoid Arthritis Disease Activity Measures: A Systematic Review and Meta-Analysis.

Arthritis Care Res (Hoboken), 2019 Dec

2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures.

Int J Rheum Dis, 2020 Sep 10

Diagnostic accuracy of 14-3-3 η protein in rheumatoid arthritis: A meta-analysis.

J Rheumatol, 2015 Jul 15

14-3-3η Autoantibodies: Diagnostic Use in Early Rheumatoid Arthritis.

Arthritis Care Res (Hoboken), 2021 Jul

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Clin Liver Dis (Hoboken), 2018 Aug 22

Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance.

BMJ Open, 2014 Aug 14

Potential risk of TNF inhibitors on the progression of interstitial lung disease in patients with rheumatoid arthritis.

Semin Arthritis Rheum, 2020 Jul 02

Recurrent rheumatoid arthritis following allogeneic bone marrow transplant and seronegativity induced by rituximab therapy.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2019-08

Abatacept as rescue immunosuppression after calcineurin inhibitor treatment failure in renal transplantation.

Transpl Int, 2022 Aug 12

Abatacept Rescue Therapy in Kidney Transplant Recipients: A Case Series of Five Patients.

Thorax, 1985 May

Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion.

Medicine, 2014 Oct

Intravenous immunoglobulin in the therapeutic armamentarium of systemic lupus erythematosus: a systematic review and meta-analysis.

Diagnostics (Basel, Switzerland), 2022 Jul 08

Anti-Carbamylated Protein (Anti-CarP) Antibodies in Patients Evaluated for Suspected Rheumatoid Arthritis.

Arthritis care & research, 2017-12

Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty.

Annals of internal medicine, 2019-06-18