Rheumatology&nbsp;&nbsp;&nbsp;

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

Are there any concerns with live vaccine innoculation and patients who are on denosumab?

When do you recommend initiation of targeted therapies in active RA with history of malignancy?

What is your most and least preferred? In case of cancer in remission and in case of non-remission?

What is the recommended approach for systemic therapy in a patient with metastatic cutaneous squamous cell carcinoma with active autoimmune disease (dermatomyositis)?

How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?

Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.

Is there evidence for development of more severe autoimmune toxicities for young patients vs older patients on immune checkpoint inhibitors?

As immune checkpoint inhibitors have expanded into the neoadjuvant breast cancer setting, severe and unexpected autoimmune toxicities may cause delays...

Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?

Do you offer adjuvant radiation therapy for a breast cancer patient with dermatomyositis?

If so, what dose-fractionation do you utilize? What other factors do you take into consideration?

What are magic mouthwash alternatives that you would recommend?

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

9 Answers available

What is your approach to working up diarrhea in an immunocompromised patient?

Do you use immune checkpoint inhibitors in NSCLC patients with pre-existing, well-controlled autoimmune disease?

Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?

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

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?

Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?

How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?

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.

Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?

How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?

How is this entity distinct from other secondary HLH entities?

What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?

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

How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?

How often should you screen for lymphoma in patients with primary Sjogren's syndrome?

Would you consider antiphospholipid syndrome to be a contraindication for checkpoint inhibitor immunotherapy?

How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?

What is the appropriate management of severe myalgia during atezolizumab infusion?

How do you interpret elevations in ESR and CRP in the setting of increased BMI?

Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers available

How would you treat a patient with active lupus nephritis (class 3/4) who requires PD-1 immunotherapy for refractory metastatic renal cell carcinoma?

What is the appropriate management of arthralgias associated with bosutinib?

Would you consider continuing a biologic for difficult to control autoimmune disease in a patient with a recent diagnosis of a surgically curable solid malignancy?

Would you favor the use of any particular biologics over others?

Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

Are there known biomarkers predictive of IRAEs?

How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

Do you offer anticoagulation to patients with prior antiphospholipid antibodies detected in pregnancy without a history of pregnancy loss or thrombosis?

What is the risk of pregnancy loss in absence of anticoagulation? What would you suggest if the patient had anticoagulation in prior pregnancies and r...

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

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

Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?

Would you still consider durvalumab consolidation after definitive chemoradiation for patients with Stage III NSCLC who are on stable weekly methotrexate dosing for psoriasis/psoriatic arthritis?

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

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

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?

How do you decide if it may be safe to continue immunotherapy?

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?

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

Do you recommend COVID vaccination in patients with antiphospholipid antibody positivity or other prothrombotic states not on anti-coagulation?

How are you timing the third dose of the COVID-19 mRNA vaccine in patients on rituximab?

Would you consider single agent TKI for patient with metastatic renal cell carcinoma who developed biopsy proven giant cell arteritis days after starting immunotherapy?

Would active vasculitis present a contraindication to therapy?

How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

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

Do you check pertussis serologies when sending labs for antiphospholipid syndrome?

For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?

Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?

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

How do you manage incidentally identified chemotherapy-associated aortitis/large vessel vasculitis?

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

What if this was "triple-negative" antiphospholipid syndrome?

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

In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?

Acknowledging that there is no time for good trials yet in this setting

Is your approach to managing immune related adverse events altered at all in light of COVID-19?

How do you approach further treatment of patients who develop grade 2-3 immune colitis from nivolumab/ipilimumab prior to completion of the 4 ipilimumab doses?

Do you re-challenge with nivolumab alone, change from nivo 1/ipi 3 to nivo 3/ipi 1 upon re-challenge, or stop immunotherapy altogether if grade 3?&nbs...

Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?

Is there a period of time after which you would not resume ICI after a patient has had an irAE and required a prolonged steroid taper?

Would the need for infliximab/MTX/nonsteroidals to control initial irAE affect your decision to rechallenge these patients with ICI?

Would you resume biologic treatments such as TNF blockers in patients with symptomatic autoimmune conditions who are in remission from their cancers?

How about those with metastatic disease eager to maintain quality of life? Do you risk progression of disease if the TNF blocker is re-started?

How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?

Is IO related pneumonitis in the radiation field or more diffuse?

How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?

In which patients with stage IV NSCLC and PD-L1 TPS >50% plus concomitant autoimmune disease is it considered safe to give immune checkpoint blockers?