Rheumatology   

Especially in an inpatient setting when EMG is not immediately available.

Are there any clinical trials underway to study additional therapies?

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

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

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

If not, are there any serum or CSF tests you consider to be helpful?

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

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

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

Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

Do you treat with only an IV steroid pulse or do you use an oral steroid taper as well? How long of a taper do you typically use?

How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Ce...

Also how would you manage this perioperatively?

In addition, what formula do you use to calculate the IgG index?

The patient has no known history of autoimmune disease.

How do you differentiate symptoms related to centralized pain syndrome from possible cognitive dysfunction?

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

Do you attempt to taper fully or maintain at a low dose?

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?

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

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?

For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...

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

I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...

e.g. DITP from eptifibatide after a cardiac intervention

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...

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

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

Is there a role for immunomodulatory therapy?

Myositis specific antibodies and pathology results often take weeks to result.  In which cases do you start therapy before the diagnosis is solid...

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)

Specifically, do you reach for Rituximab or cyclophosphamide?

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 ...