Internal Medicine

Rheumatoid Arthritis

Questions discussed in this category

How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?

Are you aware of any data regarding relative risk of molluscum contagiosum infection in reference to DMARDs/biologics?

1 Answer available

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

1 Answer available

Would you add abatacept to treat active inflammatory arthritis in a patient with history of RA-ILD who is already taking mycophenolate?

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 do you approach managing nausea and GI side effects when initiating methotrexate?

2 Answers available

Do you feel comfortable using Jak inhibitors in patients with a strong family history of CAD, but no other risk factors?

How do you counsel patients in this scenario?

1 Answer available

Is there a role for the use of transient elastography (FibroScan) to monitor liver fibrosis in patients on long term methotrexate?

3 Answers available

Do you avoid tocilizumab in patients with prior bariatric surgery given the risk of GI perforation?

2 Answers available

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

1 Answer available

How do you approach an obese patient on long-term methotrexate with normal liver tests in terms of workup for underlying fatty liver?

Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?

1 Answer available

In a patient with a Factor V Leiden heterozygous mutation but no prior thrombosis, would you consider using a JAK inhibitor for the treatment of spondyloarthritis or rheumatoid arthritis if other options have been ineffective?

1 Answer available

What are best practices in management of severe acute infusion reaction from infliximab?

Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...

1 Answer available

Would you consider utilizing a TNF-inhibitor in a patient with RA/SLE overlap who has already tried methotrexate, hydroxychloroquine, and abatacept?

Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want ...

4 Answers available

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

1 Answer available

How do you manage injection site reactions in patients on subcutaneous biologics such as TNF inhibitors?

In what cases do you discontinue the medication?

2 Answers available

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

2 Answers available

How would you approach the treatment of erosive inflammatory arthritis (RA or SpA) in a patient with multiple sclerosis on ocrelizumab who has failed csDMARD therapy?

2 Answers available

How would you approach treating patients with RA refractory to cDMARDs and a prior history of MALT lymphoma?

1 Answer available

Do you avoid dupilumab (IL-4 inhibition) for severe asthma in patients already taking a biologic agent for RA?

1 Answer available

How would you treat a poorly controlled seronegative RA patient who is steroid dependent and is on azathioprine for autoimmune hepatitis?

2 Answers available

What is your approach to monitoring lipids in patients with rheumatic diseases such as RA and SLE and do you have a lower threshold to start lipid lowering agents compared to the general population?

2 Answers available

How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?

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 would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as anti-TNF alpha therapy?

For example, healthcare workers who require these vaccines for employment

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 would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?

Do you stop methotrexate or adjust the dose?

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

Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?

5 Answers available

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

2 Answers available

Should tuberculosis screening be performed before beginning methotrexate for treatment of rheumatoid arthritis?

1 Answer available

Should methotrexate be categorically avoided in RA patients with COPD or RA-ILD?

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

How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

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

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.

Archives of internal medicine, 2008-09-22

Methotrexate is not associated with progression of interstitial lung disease in rheumatoid arthritis.

Arthritis and rheumatism, 2010-06

Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study.

Southern medical journal, 2016-11

Effects of Statin Therapy in Patients with Systemic Lupus Erythematosus.

Annals of the rheumatic diseases, 2011-05

Lupus Atherosclerosis Prevention Study (LAPS).

Atherosclerosis, 2015 Aug 28

Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study.

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.

Ann Rheum Dis, 2019 Aug 14

2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.

Arthritis and rheumatism, 1992-08

Comparison of azathioprine, methotrexate, and the combination of both in the treatment of rheumatoid arthritis. A controlled clinical trial.

Arthritis and rheumatism, 1995-12

Comparison of azathioprine, methotrexate, and the combination of the two in the treatment of rheumatoid arthritis. A forty-eight-week controlled clinical trial with radiologic outcome assessment.

Nature communications, 2021 Jun 07

Phase 1 double-blind randomized safety trial of the Janus kinase inhibitor tofacitinib in systemic lupus erythematosus.

Lancet (London, England), 2023 Feb 24

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-I).

Lancet (London, England), 2023 Feb 24

Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 3 trial (SLE-BRAVE-II).

The American journal of gastroenterology, 2003 Jun

The incidence and management of infusion reactions to infliximab: a large center experience.

The Journal of rheumatology, 2015 Jun 15

Incidence and Management of Infusion Reactions to Infliximab in a Prospective Real-world Community Registry.

RMD open, 2022 Nov

Biomarkers to predict risk of venous thromboembolism in patients with rheumatoid arthritis receiving tofacitinib or tumour necrosis factor inhibitors.

Autoimmunity reviews, 2021 Apr 19

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

Rheumatology (Oxford, England), 2021 Dec 24

Abatacept in monotherapy vs combined in interstitial lung disease of rheumatoid arthritis-multicentre study of 263 Caucasian patients.

Annals of the rheumatic diseases, 2016 Jul 12

Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs.

PloS one, 2014

IL-6 stimulates intestinal epithelial proliferation and repair after injury.

Rheumatol Int, 2021 Jan 29

Does methotrexate cause progressive fibrotic interstitial lung disease? A systematic review.

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