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Rheumatology

Rheumatology

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

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How will you incorporate nerandomilast into your treatment algorithm for autoimmune ILD with progression, particularly relative to sequencing with immunosuppression?

3 Answers

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Pulmonology · National Jewish Health

This really depends on the subtype of connected tissue disease as well as radiographic pattern. I think for anyone who requires an anti-fibrotic, nerandomilast should be considered given its excellent tolerance. A caveat is that the FIBRONEER-ILD trial excluded cyclophosphamide, toci, MMF, rituximab...

What approaches can we take to initiate therapy and improve survival rates in patients with HLH?

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Infectious Disease · UT Southwestern School of Medicine

At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...

How do you try to encourage interested medical students and residents to consider a career in rheumatology?

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Rheumatology · Berkshire Health Systems

I try to expose them to the practice of Rheumatology and the depth and breadth of what we do, not merely musculoskeletal medicine but every organ system. The beauty of the immune system when it works properly and the many ways we try to control it when it does not behave. The chronic care of these d...

In what clinical situations would you favor IM methylprednisolone over a short oral prednisone taper for managing an RA flare?

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Rheumatology · Uniformed Services University of the Health Sciences (USUHS)

I am not an RA expert; however, I am well-versed in the use of IM steroids for flares.After Dr. Petri's FLOAT study in SLE (Danowski et al., PMID 16395750), we have utilized IM steroids instead of daily PO prednisone as our "go-to" treatment of choice as much as we can over Medrol dose packs and QD ...

How do you manage patients with severe hand OA (no synovitis on exam, negative serologies) who fail to respond to NSAIDs but respond very well to oral steroids?

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Rheumatology · Sunshine Rheumatology & Arthritis Center

I have used Hydroxychloroquine with some success and offer that to patients for a trial for 4 months if they are willing.

Does significant eosinophilia (8-44%) in a patient with suspected granulomatosis with polyangiitis (GPA) based on sinusitis, pulmonary nodules and positive PR3 change your management approach?

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2 Answers

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Rheumatology · Massachusetts General Hospital

This is an important question because at times the distinction between GPA and EGPA can be difficult to make. In general, I would rely on clinical symptoms as a key distinguisher. For example, sinusitis in GPA differs from that of EGPA, with the former often causing crusting, erosions/necrosis on EN...

What findings on routine monitoring PFTs prompt you to pursue HRCT in your patients with SARDs?

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Rheumatology · Mayo Clinic

That’s an excellent question, and the strategy might vary somewhat by the specific SARD, but in general, in any SARD patient undergoing annual PFTs, the presence of any of these should prompt an HRCT to evaluate for the development of ILD. FVC drop ≥ 10% DLCO drop ≥ 15% Moderate decline in FVC (5-9...

Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?

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5 Answers

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Rheumatology · The University of Texas Health Science Center at Houston (UTHealth)

I do screen all newly diagnosed IIM patients with PFTs and chest CT. This has a double purpose: establishing a baseline of lung function and, screening for lung cancer. While the patient might not have lung symptoms on presentation, respiratory involvement can manifest later on the course of the d...

How would you approach a patient referred for esophageal aperistalsis with a longstanding history of Raynaud’s phenomenon, but without other clinical features or serologic findings suggestive of systemic sclerosis?

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Rheumatology · University of Michigan

Scleroderma esophagus (distal aperistalsis/absent contractility + hypotensive LES) is a manometric finding, not a diagnosis. There are multiple causes of this finding, including other autoimmune diseases, neuropathic conditions, and metabolic causes.In addition, RP is seen in 3-8% of the population....

In routine clinical practice, how do you operationally define ‘progression despite therapy’ in PPF to justify escalation to combination treatment?

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Rheumatology · University of Washington

ILD patients undergo regular monitoring with intervals based on concern for progression. In addition to symptom review, objective testing includes PFTs with spirometry and DLCO, 6-minute walk testing that provides information on distance walked, symptoms experienced, and whether or not the patient d...