General Rheumatology   

Are there any clinical trials underway to study additional therapies?

SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...

For example, is captopril dialyzable? 

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies? 

UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...

Can nodular scleritis be a presenting manifestation of GCA?

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

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

Normal Vitamin D, bone scan showed osteoarthritis

The patient has no extraocular features of a spondyloarthropathy and is on methotrexate. No active eye disease for past 1 year.

In which situations or patient populations do you find this useful? How is it sterilized?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

Would it be safe to resume and if so, when?

Thrombocytopenia is moderate (80-100,000 microL). No concomitant cytopenias present.

How do you approach ongoing screening for TB in patients with history of treated latent TB, but have ongoing use of DMARDs and/or biologics given quan...

How has this impacted your counseling and management?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Antibodies Before SLE.

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

How should IVIG and either biologic injections or infusions be spaced?

And if so, what is your approach to the diagnosis?

Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

ANC <500

In what cases do you discontinue the medication?

Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedan...

Are there any instances where you would prefer a biosimilar rather than the reference product? 

Patient with sacroiliitis on imaging, failure of two NSAIDs.

Would the etiology of the thrombocytosis play a role in your decision-making?

In a patient for whom rituximab is the best option for their disease management. 

Patient failed topical ocular therapies, methotrexate, azathioprine.

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

There is some emerging evidence that there is an inflammatory component. 

To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)