Mednet Logo
SpecialtiesRheumatology
Rheumatology

Rheumatology

Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.

Recent Discussions

How would you define failure of anabolic therapy for severe osteoporosis and when would you consider ordering a second round of Evenity or PTH analogue therapy?

1 Answers

Mednet Member
Mednet Member
Rheumatology · U of AZ Phoenix Dept of Orthopaedics

“Failure” of any therapy is often in the eyes of the beholder. The most efficient way to determine if there is anabolic activity is to measure a serum PINP (does not need fasting) and, for the PTH anabolic recheck, the PINP 2-3 months later. IF the delta is >10, you can be confident there is more pr...

Can you use bisphosphonates in a patient with osteoporosis who has had prior avascular necrosis of TMJ due to steroid use?

1
1 Answers

Mednet Member
Mednet Member
Rheumatology · Penn Medicine

Due to the rarity of medication-related osteonecrosis of the jaw (MRONJ) and significantly high fracture risk from osteoporosis, prior history of osteonecrosis is not considered an absolute contraindication for bisphosphonate use. The clinical picture is important in weighing this decision. If the p...

In patients with osteoporosis at high fracture risk, what factors most influence your decision to prescribe teriparatide versus abaloparatide?

3 Answers

Mednet Member
Mednet Member
Rheumatology · Icahn School of Medicine at Mount Sinai

Both abaloparatide and teriparatide are very effective anabolic agents to reduce vertebral and nonvertebral fracture risk in patients with osteoporosis (although clinical trials did not demonstrate reduction of hip fracture risk). The two agents are more similar than different and both induce an an...

How do you decide when to use acid-suppressive medications for GI prophylaxis when patients are on prolonged corticosteroid therapy?

8
3 Answers

Mednet Member
Mednet Member
Hospital Medicine · Dartmouth-Hitchcock Medical Center

We only use acid-suppressive medications for GI prophylaxis in patients treated with corticosteroids when they have additional risk factors for upper GI bleeding. Risk factors include concomitant NSAID or antiplatelet therapy, history of GI bleeding or peptic ulcer, age over 60 years, prednisone dos...

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

2
1 Answers

Mednet Member
Mednet Member
Rheumatology · MD Anderson Cancer Center

At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...

Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?

1
1 Answers

Mednet Member
Mednet Member
Rheumatology · Mayo Clinic College of Medicine

Once Avacopan is available for clinical use in the treatment of patients with AAV, providers will need to carefully weigh risks and benefits of the medication while considering other factors including cost.The ADVOCATE trial used a novel glucocorticoid toxicity index that captures common GC-related ...

Do you screen for cardiac disease in patients with dermatomyositis in the absence of symptoms?

1 Answers

Mednet Member
Mednet Member
Rheumatology · HSS

I don't typically evaluate for cardiac disease in patients with dermatomyositis who are not symptomatic. There are subtypes of myositis patients where cardiac involvement is more common (such as those with antimitochondrial antibodies and anti-SRP antibodies), and there it may make sense to keep a c...

How do you approach treatment of suspected CNS vasculitis with a negative work up?

6
3 Answers

Mednet Member
Mednet Member
Neurology · University of Calgary

Suspected CNS vasculitis is, simply put, extremely challenging, most often because the diagnosis is difficult to make. Commonly, the diagnosis is suspected based upon non-invasive imaging showing an unusual distribution of infarcts and/or evidence of intracranial arteriopathy (CTA or formal DSA). I ...

Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?

3
3 Answers

Mednet Member
Mednet Member
Rheumatology · NYU Grossman School of Medicine

This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...

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

1 Answers

Mednet Member
Mednet Member
Medical Oncology · Johns Hopkins University School of Medicine

Grade 1 pneumonitis is defined as confined to one lobe of the lung or <25% of the total lung parenchyma, while grade 2 pneumonitis is defined as involving more than one lobe of the lung or 25-50% of the lung parenchyma. Grade 1 pneumonitis is typically an incidental finding on CT in an asymptomatic ...