Questions discussed in this category
Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis?
Do you monitor patients with CTAs or MRAs?
The patient has ongoing inflammatory arthritis despite methotrexate, apremilast, and jak inhibitor trials.
Can nodular scleritis be a presenting manifestation of GCA?
Would you be comfortable combining a TNFi with Rituxan in this patient?
Vasculitis involving aorta, subclavian, common carotid, SMA, IMA, renal artery, and celiac artery.
Would you push for biopsy before deciding on treatment?
Patient is with past history of glomerulonephritis in remission after rituximab for the past 2 years. +MPO/P-ANCA
And how would you monitor response?
Is there a role in temporal artery biopsy?
The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...
This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).
The patient has not responded/has contraindications to apremilast, colchicine, and adalimumab. When they were off azathioprine for 5 days in the past,...
And when do you consider (if ever) IGRT?
Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...
Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.
Vasculitis activity has been assessed with serial CTA of the chest and head/neck. She has existing right axillary artery disease and new areas of invo...
How would you treat? Would you view tocilizumab as an option in the future?
The ADVOCATE trial only studied use for 52 weeks.
Would you proceed with CABG procedure or treat the aortitis first?
Other manifestations improved (renal function has stabilized, fatigue, arthritis, and LCV have resolved). Ophthalmologist has controlled the uveitis u...
In a patient for whom rituximab is the best option for their disease management.
Is there a role of rituximab therapy over repeat cyclophosphamide? (Cyclophosphamide induction 2 years prior)
When would you consider tapering? at one year? 18 months?
At what CD 19/20 level do you redose? Is this lab dependent?
Do you also use these levels to instruct patients when to get vaccinated?
MPO/PR3, P-ANCA negative. IgG4 normal.
Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?
What are your primary and secondary agents?
Would you obtain imaging? If so, what type of imaging?
Is there a role for monitoring for relapse or increased disease activity as opposed to scheduled dosing?
Is there role for IVIG? Would you alter the dose or time course of steroid therapy?
In your experience, are there specific disease manifestations in which HLAB51 is particularly helpful?
Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease?
Would you suggest switching to a viral vector vaccine, such as J&J?
How does this vary from continued disease monitoring?
Additionally, what is the current role for temporal artery ultrasound in workup for GCA?
Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?
Thoughts on sarilumab vs methotrexate, or just treat with steroids alone
Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)
There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...
Would you change rituximab maintenance dose or schedule?
Specifically, do you reach for Rituximab or cyclophosphamide?
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...
Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...
What if the patient has MGUS?
Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?
How would you label such a patient?
Would you treat differently if they have poor functional status?
If you use both, how do you decide which to use for a particular patient?
218842145121247188092139721244210742092720758206472014018712203101995718749198137313195091958311146190121944417911190921883118487189491758413509186981858718475183921830784731701718206181421771717665176311733916939166811412914220165421587615734142621508715088150671486414822146661458613272142531397712454136511353813435134551335312678107351298812855127591276312036124161244312099119361146811106108951153411351109741073710622106188388104501027510267102181006197559422970096149567941794218827899293489322862192348903888688538885854286868485847973148347842884168355828281188071808380147967796678687115
Papers discussed in this category
N Engl J Med, 2020 Feb 13
The New England journal of medicine, 2010-07-15
Medicine (Baltimore),
The New England journal of medicine, 2010-07-15
,
Ann. Rheum. Dis., 2018 Apr 25
Ann. Rheum. Dis., 2017 May 25
Ann. Rheum. Dis., 2018 May 03
Medicine, 1976-05
Arthritis and rheumatism, 2010-01
J. Rheumatol., 2019 Sep 01
Annals of the rheumatic diseases, 2009-03
BJR Case Rep, 2018 Sep 08
Ann Intern Med, 2020 Sep 22
Curr Rheumatol Rep, 2020 Oct 16
N Engl J Med,
Lancet, 2016 Mar 04
JAMA network open, 2018-11-02
Rheumatol Int, 2020 Sep 18
The New England journal of medicine, 2017-05-18
Kidney international reports, 2018-03
Rheumatology (Oxford),
The Journal of rheumatology, 2012-02
Rheumatology (Oxford, England), 2011-12
Nat Rev Neurol,
Nat Rev Dis Primers, 2018 Aug 02
N Engl J Med, 2021 Feb 18
Rheumatology (Oxford),
Ann Intern Med,
Ann Rheum Dis, 2011 Nov 29
Annals of internal medicine, 1994-06-15
Front Neurol, 2019 Jun 06
Curr Opin Rheumatol,
Arthritis Rheum,
Seminars in arthritis and rheumatism, 2012-06
Arthritis Rheumatol, 2021 Jul 08
Ann Rheum Dis, 2019 Jul 03
Radiographics : a review publication of the Radiological Society of North America, Inc, 2001
International journal of clinical rheumatology, 2010
Mayo Clin Proc,
Neurology, 2019 Jan 11
Seminars in arthritis and rheumatism, 2016-02
Bull Soc Ophtalmol Fr,
Am J Hum Genet, 2021 Jan 7
Ann Rheum Dis, 2021 Jul 02
RMD Open, 2021 Sep
J Dermatol,
Arthritis Rheum,
J Am Acad Dermatol, 2021 Jul 02
Arthritis Care Res (Hoboken), 2020 May 19
J Rheumatol, 2021 Feb 15
Rheumatology (Oxford),
Eur J Cancer, 2021 Sep 15
Thorac Cancer, 2020 Feb 11
The New England journal of medicine, 2013-08-01
N Engl J Med,
N Engl J Med,
Rheumatol Int, 2014 Jun 05
Heart, 2021 Feb 16
Arthritis Rheumatol, 2019 Nov 04
Arthritis Rheumatol, 2022 Jun 20
Journal of vascular surgery, 2006-01
Rheumatology (Oxford), 2022 Jul 06
Clin Exp Rheumatol, 2022 Nov 02
Mayo Clinic proceedings, 2018-11
Kidney Int, 2017 May 12
Arthritis Rheumatol, 2020 Sep 6
Rheumatology (Oxford, England), 2015-03
Annals of the rheumatic diseases, 2011 Sep 16
Open access rheumatology : research and reviews, 2016
Medicine, 2016 Feb
Histopathology, 2023 Aug 08
Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology, 2023 Sep 06
Current opinion in rheumatology, 2018 Jul
European journal of medical research, 2009 Dec 07
Annals of the rheumatic diseases, 2018 Jun 27
Annals of the rheumatic diseases, 2024 Jan 11
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2012-08
Current medical research and opinion, 2016-12
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015-05
J Immunother Cancer, 2021 Jul
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2016 Jul 07
Arthritis & rheumatology (Hoboken, N.J.), 2019 Oct 21
European journal of cancer (Oxford, England : 1990), 2023 Dec 28
Arthritis and rheumatism, 2006 Mar
Annals of the rheumatic diseases, 2016 Jul 12
PloS one, 2014
Current opinion in pulmonary medicine, 2023 Jun 30
Rheumatology (Oxford, England), 2023 Feb 01
JAMA otolaryngology-- head & neck surgery, 2020 Jan 01
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2024 Mar 14
Antibiotics (Basel, Switzerland), 2023 May 29
Clinical kidney journal, 2016 Nov 10
Expert review of anticancer therapy, 2009-01
Lancet Gastroenterol Hepatol, 2023 Feb 01