theMednetRegister

General Internal Medicine

Vasculitis   

Questions discussed in this category

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?
1 Answer available
How do you determine which patients with ANCA associated vasculitis may be good candidates for reduced dose glucocorticoid tapering?
This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspi...
1 Answer available
How soon after starting treatment for Takayasu arteritis do you decide on the need for any vascular interventions to manage chronic damage?
2 Answers available
How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?
Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis? 
1 Answer available
How soon after starting treatment would you repeat imaging in patients with Takayasu to monitor response and ensure you have the correct diagnosis?
Do you monitor patients with CTAs or MRAs?
1 Answer available
How would you approach management of nodular scleritis in the setting of suspected GCA?
Can nodular scleritis be a presenting manifestation of GCA?
1 Answer available
How would you approach the workup and management of a young patient with recurrent biannual non-scarring oral ulcers and new onset neurologic symptoms with associated CNS white matter lesions concerning for Behcet’s?
1 Answer available
How would you approach the workup and management of isolated inflammatory subglottic stenosis in a young previously healthy patient that is steroid responsive with a completely negative serologic autoimmune workup?
Would you push for biopsy before deciding on treatment?
1 Answer available
How do you approach the workup of clinically diagnosed cutaneous vasculitis in healthy young individuals without systemic symptoms?
1 Answer available
How do you approach the work up of pulmonary artery aneurysm in the absence of other clinical features of Behcet’s?
1 Answer available
What features on CTA/MRA are most helpful for differentiating large vessel vasculitis from atherosclerosis?
1 Answer available
What is your approach to management of pulmonary fibrosis in patients with a history of microscopic polyangiitis who do not have other active organ involvement?
Patient is with past history of glomerulonephritis in remission after rituximab for the past 2 years. +MPO/P-ANCA
1 Answer available
Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?
1 Answer available
Would you stop azathioprine in a patient with ANCA vasculitis who has been in long term remission on azathioprine, but has a new diagnosis of lung cancer requiring initiation of immunotherapy?
2 Answers available
When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?
3 Answers available
Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?
2 Answers available
How would you approach the work up of a patient with nasal septal perforation, a negative infectious workup, and negative ANCA titers?
1 Answer available
How would you approach a patient with new temporal headache, temporal artery tenderness and TA biopsy with mild thickening, but normal inflammatory markers?
1 Answer available
What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?
2 Answers available
What is your approach to further workup and treatment of abdominal aortitis found on imaging in asymptomatic individuals with elevated inflammatory markers?
Is there a role in temporal artery biopsy?
1 Answer available
How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?
1 Answer available
How would you treat a young patient who presents with coronary vasculitis and aortitis with persistently positive MPO but no other features of AAV?
2 Answers available
How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?
2 Answers available
Would you continue Rituximab infusions in a patient with GPA and renal involvement who has been in remission on Avacopan and Rituximab, but had PRES post Rituximab infusion?
1 Answer available
How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?
The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...
1 Answer available
Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?
This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).
2 Answers available
Would you check ANCA titers in a patient with a history of PR-3-ANCA glomerulonephritis in remission and a stable creatinine but with recurrent microscopic hematuria?
6 Answers available
How would you approach peri-operative immunosuppressive management of a patient with Behcet's, currently controlled on azathioprine, who needs genital surgery?
The patient has not responded/has contraindications to apremilast, colchicine, and adalimumab. When they were off azathioprine for 5 days in the past,...
2 Answers available
Do you recommend monitoring IgG level in patients with AAV receiving rituximab?
And when do you consider (if ever) IGRT?
1 Answer available
Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?
Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...
2 Answers available
How would you approach management of incidentally identified unilateral retinal vasculitis with subsequent labs revealing +P-ANCA?
Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.
2 Answers available
Do you continue to utilize ESR and CRP in patients on tocilizumab?
2 Answers available
How would you approach a patient with incidentally noted infrarenal periaortitis with positive C-ANCA, normal inflammatory markers and no systemic symptoms?
MPO/PR3, P-ANCA negative. IgG4 normal.
1 Answer available
Do you routinely screen for pulmonary artery aneurysm in patients with Behcet's?
1 Answer available
How do you approach treating idiopathic aortitis?
What are your primary and secondary agents?
1 Answer available
How would you approach a rising PR3 in a patient with limited GPA who is currently asymptomatic on methotrexate?
Would you obtain imaging? If so, what type of imaging?
1 Answer available
How would you treat systemic polyarteritis nodosa with orchitis, mononeuritis and glomerulonephritis in a person who is being treated for HiV with low level viremia?
2 Answers available
How do you approach differentiating segmental arterial mediolysis from abdominal vasculitis?
1 Answer available
When do you consider tapering tocilizumab in patients with GCA in remission?
1 Answer available
What is your approach to the workup for an underlying systemic condition in a patient presenting with retinal vasculitis?
1 Answer available
How important do you feel HLAB51 testing is in diagnosing Behcet's disease?
In your experience, are there specific disease manifestations in which HLAB51 is particularly helpful?
1 Answer available
How do you approach relapsing ANCA-associated vasculitis in a patient who has already undergone kidney transplant?
1 Answer available
Can giant cell arteritis present with a partial cranial neuropathy?
3 Answers available
How do you approach treating cutaneous PAN?
Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 
1 Answer available
What is your approach to initial assessment of disease extent in patients with Behcet's disease?
How does this vary from continued disease monitoring?
1 Answer available
How would you approach new-onset large vessel vasculitis in a young patient with Crohn's disease?
3 Answers available
Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?
2 Answers available
Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?
Additionally, what is the current role for temporal artery ultrasound in workup for GCA?
3 Answers available
What is the utility in repeating a temporal ultrasound (US) in a previously US diagnosed positive GCA patient who has received treatment and is presenting with recurrent GCA symptoms?
1 Answer available
Is there any experience of using sarilumab instead of tocilizumab for steroid sparing effect in GCA during national tocilizumab shortage?
1 Answer available
What is the role for angiography in the workup of digital ischemia?
Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?
1 Answer available
What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?
Thoughts on sarilumab vs methotrexate, or just treat with steroids alone
1 Answer available
Would you pursue temporal artery biopsy in patients with PMR who develop cranial GCA symptoms and have been on PMR dose steroids for one year?
1 Answer available
How do you approach treatment of vasculitis in a sickle cell disease patient?
There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...
1 Answer available
Would you start tocilizumab in a patient with temporal arteritis and cirrhosis?
1 Answer available
Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?
ADVOCATE trial
1 Answer available
How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?
What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?
1 Answer available
How would you approach a patient with MPO-positive isolated peripheral nerve vasculitis?
How would you label such a patient?  Would you treat differently if they have poor functional status?
2 Answers 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
Should all patients with suspected giant cell arteritis get a PET scan to look for large vessel disease?
3 Answers available
What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide? 
1 Answer available
How do you approach a patient found to have a coronary lesion suggestive of vasculitis on coronary CT?
1 Answer available
Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?
1 Answer available
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
2 Answers available
At what point in GCA management do you typically introduce tocilizumab?
2 Answers available
How do you counsel Takayasu patients on their prognosis?
2 Answers available
How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?
1 Answer available
Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?
2 Answers available
When is a biopsy necessary to diagnose relapsing polychondritis?
1 Answer available
What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?
1 Answer available
What do you use to treat a GCA patient refractory to methotrexate who responded but had adverse effects with both tocilizumab and sarilumab?
1 Answer available
When do you stop immunosuppressants in patients with GPA?
1 Answer available


Papers discussed in this category

Medicine, 1976-05
Relapsing polychondritis: prospective study of 23 patients and a review of the literature.
Arthritis and rheumatism, 2010-01
Incidence and prevention of bladder toxicity from cyclophosphamide in the treatment of rheumatic diseases: a data-driven review.
J. Rheumatol., 2019 Sep 01
Malignancies in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis: A Population-based Cohort Study.
Ann. Rheum. Dis., 2018 May 03
Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides.
Curr Rheumatol Rep, 2020 Oct 16
Morbidity and Mortality of Large-Vessel Vasculitides.
Ann. Rheum. Dis., 2018 Apr 25
Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2).
N Engl J Med,
Trial of Tocilizumab in Giant-Cell Arteritis.
Lancet, 2016 Mar 04
Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.
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.
The Journal of rheumatology, 2012-02
Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis.
The New England journal of medicine, 2010-07-15
Rituximab versus cyclophosphamide for ANCA-associated vasculitis.
Rheumatology (Oxford, England), 2011-12
Peripheral neuropathy in ANCA-associated vasculitis: outcomes from the European Vasculitis Study Group trials.
Nat Rev Neurol,
The nonsystemic vasculitic neuropathies.
Nat Rev Dis Primers, 2018 Aug 02
Cryoglobulinaemia.
N Engl J Med, 2021 Feb 18
Avacopan for the Treatment of ANCA-Associated Vasculitis.
Annals of internal medicine, 1994-06-15
How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis?
Curr Opin Rheumatol,
Retinal vasculitis.
Arthritis Rheum,
Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis.
Seminars in arthritis and rheumatism, 2012-06
Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis.
Arthritis Rheumatol, 2021 Jul 08
2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis.
Ann Rheum Dis, 2019 Jul 03
2018 Update of the EULAR recommendations for the management of large vessel vasculitis.
Radiographics : a review publication of the Radiological Society of North America, Inc, 2001
Polyarteritis nodosa: spectrum of angiographic findings.
International journal of clinical rheumatology, 2010
Raynaud's phenomenon and digital ischemia: a practical approach to risk stratification, diagnosis and management.
Mayo Clin Proc,
My Treatment Approach to Giant Cell Arteritis.
Neurology, 2019 Jan 11
RCVS score and diagnostic approach for reversible cerebral vasoconstriction syndrome.
Seminars in arthritis and rheumatism, 2016-02
Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature.
Bull Soc Ophtalmol Fr,
[Uveal effusion syndrome secondary to orbital cellulitis].
Am J Hum Genet, 2021 Jan 7
Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study.
Ann Rheum Dis, 2021 Jul 02
Ultrasound halo sign as a potential monitoring tool for patients with giant cell arteritis: a prospective analysis.
J Dermatol,
Cutaneous polyarteritis nodosa: a clinical and histopathological study of 20 cases.
Arthritis Care Res (Hoboken), 2020 May 19
Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta-Analysis.
J Rheumatol, 2021 Feb 15
Real-world Risk of Relapse of Giant Cell Arteritis Treated With Tocilizumab: A Retrospective Analysis of 43 Patients.
Rheumatology (Oxford),
Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis.
Heart, 2021 Feb 16
Aortitis: recent advances, current concepts and future possibilities.
Arthritis Rheumatol, 2019 Nov 04
Outcomes Among 196 Patients With Noninfectious Proximal Aortitis.
Arthritis Rheumatol, 2022 Jun 20
Global Transcriptomic Profiling Identifies Differential Gene Expression Signatures Between Inflammatory and Noninflammatory Aortic Aneurysms.
Rheumatology (Oxford, England), 2015-03
Large-vessel giant cell arteritis: a cohort study.
Open access rheumatology : research and reviews, 2016
Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment.
Medicine, 2016 Feb
Description and Validation of Histological Patterns and Proposal of a Dynamic Model of Inflammatory Infiltration in Giant-cell Arteritis.
Histopathology, 2023 Aug 08
Age-related histopathological findings in temporal arteries.
Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology, 2023 Sep 06
Consensus statement on the processing, interpretation and reporting of temporal artery biopsy for arteritis.
Annals of the rheumatic diseases, 2024 Jan 11
Rituximab as maintenance therapy for ANCA-associated vasculitides: pooled analysis and long-term outcome of 277 patients included in the MAINRITSAN trials.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2012-08
Cyclophosphamide without corticosteroids for treatment of severe systemic necrotizing vasculitis.
Current medical research and opinion, 2016-12
Corticosteroids: the knee jerk response.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015-05
Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis.
J Immunother Cancer, 2021 Jul
Timing of steroid initiation and response rates to immune checkpoint inhibitors in metastatic cancer.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2016 Jul 07
Azathioprine and Risk of Skin Cancer in Organ Transplant Recipients: Systematic Review and Meta-Analysis.
Arthritis & rheumatology (Hoboken, N.J.), 2019 Oct 21
Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study.
European journal of cancer (Oxford, England : 1990), 2023 Dec 28
Effects of an immunosuppressive therapy on the efficacy of immune checkpoint inhibition in metastatic melanoma - An analysis of the prospective skin cancer registry ADOREG.
Arthritis and rheumatism, 2006 Mar
Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis.
Current opinion in pulmonary medicine, 2023 Jun 30
Interstitial lung disease in patients with anti-neutrophil cytoplasm antibody-associated vasculitis: an update on pathogenesis and treatment.
Rheumatology (Oxford, England), 2023 Feb 01
Interstitial lung disease in ANCA-associated vasculitis: associated factors, radiographic features and mortality.
JAMA otolaryngology-- head & neck surgery, 2020 Jan 01
Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2024 Mar 14
Medical Maintenance Therapy Following Laser Excision in Patients With Granulomatosis With Polyangiitis (GPA)-Associated Subglottic Stenosis.
N Engl J Med, 2020 Feb 13
Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis.

Related Topics in General Internal Medicine

Copyright © 2025 theMednet
All Rights Reserved.