Primary Care

Rheumatoid Arthritis

Questions discussed in this category

What is your approach to monitoring patients referred for high titer +RF and +CCP but without active symptoms of inflammatory arthritis?

X-rays without inflammatory changes. RF >120, CCP >250.This question is part of a collaboration with RheumMadness and is specifically in referen...

5 Answers available

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

5 Answers available

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

How would you approach management of a patient who develops squamous cell skin cancer while on abatacept?

Patient has had previous failure of methotrexate. Would you switch to alternative (TNFi or Rituximab) or continue abatacept with regular dermatology...

2 Answers available

What is your treatment approach for a young female who has an idiopathic small right elbow effusion with synovial thickening that has resulted in limitation in her range of motion?

1 Answer available

How do you counsel patients with RA stable on csDMARDs on whether to attempt tapering or not?

While remission rates after lowering or discontinuing therapy are lower, there is still a population of patients who do not require full-dose therapy ...

2 Answers available

How do you approach medication management in patients with RA when transitioning from csDMARD triple therapy to anti-TNF?

Which csDMARD do you taper in order, and is there a tapering strategy (duration/dose)?

2 Answers available

Are you comfortable with using NSAIDs in a patient on methotrexate for inflammatory arthritis?

Given the drug-drug interaction, do you monitor more closely for methotrexate toxicity, counsel on symptoms of methotrexate toxicity, or avoid the com...

2 Answers available

Do you combine methotrexate and leflunomide for the treatment of RA?

3 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

What is your approach for cancer screening for elderly onset RA?

1 Answer available

Would you escalate therapy in a patient with rheumatoid arthritis without synovitis, but a new rheumatoid nodule?

Do you consider the appearance of a new rheumatoid nodule as a sign of RA activity?

1 Answer available

What is your approach to work up for patients referred for early onset osteoarthritis?

1 Answer available

Would you uptitrate methotrexate dosing when a patient flares on a TNFi and methotrexate 15 mg weekly?

2 Answers available

How do you approach monitoring when using combination JAK inhibitors and methotrexate in RA?

1 Answer available

How do you counsel patients who prefer to continue TNFi therapy indefinitely for rheumatoid arthritis despite long-standing remission?

Do you advocate to taper the TNF-i or simply continue to monitor for long term adverse events? This question is part of a collaboration with Rheu...

3 Answers available

What is your approach to leflunomide and statin use in RA patients?

Is the interaction considered severe?

2 Answers available

Would you continue Jak inhibitor therapy in a patient with long standing, previously refractory RA in their 60s who was found to have stenosis of the left common femoral artery and no other history of arteriosclerotic disease?

1 Answer available

Would you consider the use of doxycycline or minocycline in the management of RA?

4 Answers 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

How would you approach rheumatoid arthritis treatment for widespread large rheumatoid nodules but no active synovitis or subjective joint pain?

Patient taken off methotrexate.

2 Answers available

Would you have a patient temporarily discontinue methotrexate while receiving a FAST or FAST FORWARD regimen for breast irradiation?

The patient is on a dose of 22 mg of methotrexate weekly for severe rheumatoid arthritis. If you would discontinue the methotrexate, how long would y...

1 Answer available

How do you approach methotrexate management around vaccines other than COVID and influenza?

Data is clear that we should hold methotrexate at least one week after COVID and flu vaccines. How do you approach methotrexate management around Shin...

1 Answer available

How often do you monitor labs in patients taking methotrexate?

4 Answers 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

In an RA patient with positive RF and CCP abs who is stable on TNFi biologic, how would you approach incidentally found low titer positive DsDNA abs?

Would you switch to a non TNFi biologic or continue current regimen with careful monitoring for evolution of lupus manifestations?

2 Answers available

What is your approach to patients with positive anti-CCP, negative RF and tobacco use, but no current signs of active rheumatoid arthritis?

1 Answer available

How do you approach methotrexate management in patients with rheumatoid arthritis and moderate NASH but no fibrosis per FibroSURE?

Continue MTX with monitoring of LFTs vs switching to another oral DMARD (aza, lef) vs GI for fibroscan?

1 Answer available

Do you ever consider using a higher dose of upadacitinib (30 mg daily) for rheumatoid arthritis in patients who fail to respond/partially respond to established dosing of 15 mg daily?

1 Answer available

How do you approach treatment of RA with methotrexate in a patient with treated Hepatitis C and normal liver function?

1 Answer available

What bDMARD would you choose for a patient with RA with high infection risk and inadequate response to cDMARDs?

Infection risk being primarily chronic venous stasis ulcers

1 Answer available

What is your approach to discussing risk of adverse cardiovascular events in patients with RA whom you are considering starting a JAK inhibitor?

Data is mixed based on the results of ORAL surveillance, STAR-RA and nationwide cohort studies.

2 Answers available

How do you approach tapering off JAK inhibitors in patients with rheumatoid arthritis who are in sustained remission?

3 Answers available

How do you weigh the risks of re-treatment with infliximab in a patient who has been off it for over a year?

2 Answers available

When do you consider referral to hand surgery for management of joint deformity in RA?

2 Answers available

Do you counsel your RA patients to hold their methotrexate dose for simple infections such as UTIs?

1 Answer available

How do you approach CV risk assessment in RA patients when RA itself is associated with some degree of increased CV risk at baseline?

Recent articles regarding the use of JAK-Inhibition in RA have suggested to avoid in patients with increased CV risk. However, RA itself is cons...

2 Answers available

Would you recommend that a patient with stable coronary artery disease and well-controlled RA on a JAK inhibitor continue on their current therapy?

2 Answers available

Do you still plan to offer tofacitinib to RA patients over 65 if they have one or more additional CV risk factors?

2 Answers available

How do you counsel patients regarding the cardiovascular and cancer risks associated with tofacitinib?

2 Answers available

How long would you treat with antimycobacterials before starting biologic DMARD in a patient with latent TB and active rheumatoid arthritis?

1 Answer available

What is your approach to a patient with rheumatoid arthritis and moderate disease activity on 25 mg of PO methotrexate?

Do you switch to SQ MTX, or is it best to add tx, such as a TNFi?

1 Answer 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

What is your methotrexate initiation strategy in DMARD-naive RA patients?

Specifically: starting dose, rapidity of up-titration, frequency of lab monitoring, frequency of office visits, and timing of assessment for treatment...

2 Answers available

What is your approach to a patient with an isolated positive rheumatoid factor, negative anti-CCP antibody, and no clinical or imaging evidence of rheumatoid arthritis?

3 Answers available

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

1 Answer 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

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

When would you recommended restarting biologic medications in an active RA patient after treatment with monoclonal antibodies, convalescent plasma or antiviral medications for a COVID-19 infection?

1 Answer available

Do you switch to certolizumab in RA patients who are doing well on other TNFis and planning to become pregnant?

1 Answer available

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

5 Answers available

Is a comprehensive physical exam with vital signs warranted for routine follow-up visits in well-controlled uncomplicated RA patients?

Reduced requirements for documentation by CMS in 2021 with respect to billing and coding have raised new questions about what aspects of physician exa...

1 Answer available

Should MTX be avoided in RA patients with asymptomatic lung nodules?

If so, what would be an ideal DMARD in this setting?

1 Answer available

How do you approach patients with overlapping features of PMR and seronegative RA?

1 Answer available

Should JAK inhibitors and anti-IL6 medications be avoided in patients with known diverticulosis?

2 Answers available

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

1 Answer available

What is your approach to dental prophylaxis for patients on biologics?

1 Answer available