Internal Medicine

Vasculitis   

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? 

The patient has ongoing inflammatory arthritis despite methotrexate, apremilast, and jak inhibitor trials.

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,...

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

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...

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. 

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?

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?

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? 

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?

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...

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?


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

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Ann. Rheum. Dis., 2018 Apr 25

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Medicine, 1976-05

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J. Rheumatol., 2019 Sep 01

Annals of the rheumatic diseases, 2009-03

BJR Case Rep, 2018 Sep 08

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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