Systemic lupus erythematosus
Questions discussed in this category
I'm uncertain why both individual parts can be so low/negative but together very positive. Is there an assay discrepancy, a false positive?
SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...
Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?
UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...
The index question is: "neurosurgeons lately want to stop hydroxychloroquine prior to spinal surgery. Anyone allowing this for lupus patients and for ...
If a patient has received a kidney transplant for SLE-LN and is stable and doing well. Managed by their transplant team and on chronic immunosuppressi...
The case prompting the question is a female in her late teens who was diagnosed with Class IV LN at her prepubescent age and was treated with HCQ and ...
What factors do you discuss when counseling the patient?
How does the presence of extra-renal manifestations influence this decision?
The patient is already on hydroxychloroquine.
And have you ever seen it occur in isolation without any other manifestations of SLE?
When do you decide to hospitalize?
MRI with muscle edema but biopsy pending. Would you consider this overlap myositis even though muscle enzymes are normal?
For example, the patient may have other findings such as an elevated CRP. Would you diagnose SLE, or would you want to see other serologies or finding...
How long has it been back on the market? What is the typical cost for patients? Are certain compounding pharmacies regularly carrying it?
How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (b...
Do you refer all patients with suspected LN, patients with confirmed LN, or patients with specific features (not responding to usual therapy, certain ...
What disease activity index do you find more useful and most practical in a busy clinical setting? How often do you assess it?This question is part of...
Do you add low-dose mycophenolate to use in combination with Rituximab in these patients?
For example, when switching from MMF to azathioprine, do you overlap the treatments as you lower the dose of one and add the other?
Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...
Would you still plan for lifelong anticoagulation in this scenario?
This question is part of a collaboration with RheumMadness and is specifically in reference to: Antibodies Before SLE.
ANA patients referred to rule out CTD is a work-intensive, costly referral type. If they are positive for Anti-Dense Fine Speckled Protein 70 kDa (DFS...
Low EF in the range of 30%
(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...
Additionally, is it correct to assume that IV therapies might be preferred vs oral treatment given alterations in GI absorption in PLE?
And if so, what is your approach to the diagnosis?
Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want ...
A specific example would be a clinically quiescent but serologically active patient.
Extrapolating from reactions with other sulfa medications potentially causes flares.
Do you do blood work? Or do you rely on review of systems?
(C3 just below normal, C4 undetectable)
In addition, what formula do you use to calculate the IgG index?
Do you typically start the patient on hydroxychloroquine?
What work-up do you perform?
A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...
There are studies that show hydroxychloroquine inhibits autophagy (the orderly degradation and recycling of the contents of the cytoplasm for the cell...
Classically, lupus mouth ulcers are large non-painful blisters at the roof of the mouth. What do you do with small scattered blisters, painful or not ...
For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...
Patient with sacroiliitis on imaging, failure of two NSAIDs.
I get a lot of low false positive ds dna (sometimes high- 300) in quest and labcorp but their crithidia specific dsDNA labs when repeated are ne...
This question is part of a collaboration with RheumMadness and is specifically in reference to: Hydroxychloroquine Withdrawal.
If a deficiency is present, do you consider IVIG to treat non-infectious symptoms such as skin rash, arthritis or hematological abnormalities?
Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...
Patient failed topical ocular therapies, methotrexate, azathioprine.
What would you suggest to help address these disparities in our own practices?
This question is part of a collaboration with RheumMadness and is specifically in reference to: EMBRACE
Patients frequently mention diagnosis of SLE years ago but recent Sm, dsDNA (crithidia) and complements can be normal. Can treatment with medications ...
And if so, are the target levels similar?
Such as patients with negative Hepatitis B surface antigen and negative viral load but with positive hepatitis b core antibody.
When would you de-escalate therapy?
(assuming that the malignancy evaluation has been completed and the lymphadenopathy is confirmed to be reactive)
Do you routinely check IgA anticardiolipin and beta-2 glycoprotein antibody IgA in your practice? And how would a positive result change your manageme...
i.e. obstretric APS without thrombosis or SLE
In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect?
Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?
If so, are there specific patient populations for which you would use this metric?
To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)
How do you counsel these patients about hormonal agents?
Did the recently published BLISS-LN trial change your practice?
This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet
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Papers discussed in this category
Arthritis and rheumatism, 2012-04
Ann Rheum Dis, 2013 Jun 05
Arthritis and rheumatism, 2005-09
Arthritis & rheumatology (Hoboken, N.J.), 2015-05
Lupus,
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Clin Rheumatol, 2006 Dec 21
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Annals of the rheumatic diseases, 2011-10
Arthritis Rheum,
Rheumatol Int, 2019 Apr 30
Clin Exp Rheumatol, 2012 Sep 25
Wien Klin Wochenschr,
Kidney international, 2019-01
Clinical journal of the American Society of Nephrology : CJASN, 2008-01
Lancet, 2021 May 07
Lancet (London, England), 2011 Feb 04
Arthritis & rheumatology (Hoboken, N.J.), 2023 Jul 19
J Rheumatol, 2006 Jul 01
Semin Arthritis Rheum,
Lupus, 2008-08
Arthritis Rheumatol, 2021 Aug 12
Int J Clin Pract, 2021 Mar 24
Mod Rheumatol, 2021 Feb 09
Heart Rhythm, 2020 Jun 28
Blood,
Arthritis care & research, 2018-03
J Clin Rheumatol, 2020 Sep 18
Cureus, 2020 Aug 02
The New England journal of medicine, 2003-10-16
Lupus, 2007
J Allergy Clin Immunol, 2020 May 22
Nat Rev Rheumatol,
Kidney international, 2009-12
Clinical journal of the American Society of Nephrology : CJASN, 2010-07
Journal of the American Society of Nephrology : JASN, 2010-08
Am J Kidney Dis, 2016 Sep 16
J Rheumatol, 2004 Aug
Arthritis & rheumatology (Hoboken, N.J.), 2015-07
Arthritis Rheum,
Autoimmunity reviews, 2009-02
Arthritis and rheumatism, 2013-07
Arthritis Rheumatol, 2021 Mar 24
Rev Med Interne, 2016 Oct 13
Arthritis Care Res (Hoboken), 2021 Mar 30
JAMA Dermatol,
Mod Rheumatol, 2020 Sep 17
Ann Rheum Dis, 2014 Feb 13
Ann Rheum Dis, 2019 Jan 04
Ann Rheum Dis, 2014 Apr 16
N Engl J Med, 2019 Dec 18
Seminars in arthritis and rheumatism, 2010-12
Clin Exp Rheumatol, 2012 Oct 17
Inflamm Bowel Dis,
Am J Clin Dermatol,
Journal of the American Society of Nephrology : JASN, 1993-07
Arthritis and rheumatism, 2013-02
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2014-02
Lupus, 2018-03
Annals of the rheumatic diseases, 2019-10
Lupus,
Arthritis Rheum,
Rheumatology (Oxford), 2021 May 18
Am J Transplant, 2013 Jun 13
Best practice & research. Clinical anaesthesiology, 2014-06
The Journal of rheumatology, 2016-08
JCI Insight, 2021 Feb 08
Arthritis Rheumatol, 2021 Jun 01
Adv Ther, 2018 Mar 20
J Arthroplasty, 2017 Jun 19
Int J Mol Sci, 2020 Mar 04
Open Access Rheumatol, 2019 Jan 29
Respirology, 2016 Dec 17
Lupus, 2013-07
Arthritis care & research, 2019-07
Arthritis care & research, 2019-11
J Rheumatol,
Lupus Sci Med, 2018 May 14
Lupus Sci Med,
Lupus, 2015 Jul 10
Lupus science & medicine, 2014
The Journal of rheumatology, 2015-11
Ophthalmology, 2016-06
Lupus science & medicine, 2017
Journal of immunology research, 2017
Lupus science & medicine, 2018
Clin Pharmacol Ther, 2018 Jun
Lupus Sci Med, 2016
Lupus Sci Med, 2016 Feb 01
Lupus Sci Med,
ACR Open Rheumatol, 2020 Oct 12
Arthritis Rheumatol, 2021 May 02
Ann Rheum Dis, 2012 Nov 10
Arthritis Rheum,
Lupus,
Arthritis Rheumatol, 2020 Jan 07
Annals of the rheumatic diseases, 2012-08
J Rheumatol, 2013 Nov 15
Arthritis Res Ther, 2005 Mar 01
JAMA Ophthalmol, 2015 Oct
JAMA, 2022 Oct 11
Front Immunol, 2021 May 14
Lupus Sci Med, 2019
Current rheumatology reports, 2018-09-10
Nat Rev Cardiol, 2019 Jun 26
Seizure, 2020 Apr 26
The American journal of medicine, 1996-07
BMC Nephrol, 2020 Oct 28
Arthritis Rheum,
Thromb Haemost, 2020 Jul 21
Best practice & research. Clinical rheumatology, 2013-06
Dermatol Ther, 2016 Apr 12
The Journal of rheumatology, 1992-02
The British journal of dermatology, 2011-03
Current opinion in rheumatology, 2018-09
Lupus, 2014 Feb 20
Ann Rheum Dis, 2019 Feb 04
Br J Dermatol, 2011 Jul 11
Mod Rheumatol, 2016 Feb 17
BMJ open, 2019-03-20
J Inflamm Res, 2020 Sep 14
Arthritis Rheumatol, 2017 Apr 07
The Journal of rheumatology, 2013-05
Lupus, 2013-02
Archives of internal medicine, 2004
Lupus, 2021 Jan 05
Arthritis Rheumatol, 2018 Jun 27
Curr Cardiol Rep, 2021 Jul 28
Clin Exp Rheumatol, 2013 Aug 02
Arch Dermatol,
Lupus, 2017 Sep 01
Lupus, 2016 May 27
Br J Dermatol, 2019 Apr 07
Lupus, 2020 Apr 21
Autoimmun Rev, 2012 Nov 30
Ann Rheum Dis, 2022 Mar 25
Lupus science & medicine, 2018
Arthritis Rheum,
Ther Adv Musculoskelet Dis, 2022 Feb 14
Sleep Breath, 2021 Nov 12
Rheumatol Int, 2019 Jan 02
Lupus,
Clin Immunol, 2020 Oct 02
Ann Intern Med,
Sleep,
Worldviews Evid Based Nurs, 2017 Apr 22
Am J Clin Dermatol,
Lupus, 2020 Feb 09
Am J Med,
Front Immunol, 2021 Jul 14
J Rheumatol, 2017 May 15
Ophthalmology, 2014-10
Br J Ophthalmol, 2015 Apr 22
Am J Ophthalmol,
Transplant Proc,
The American journal of medicine, 1983-09
Arthritis care & research, 2011-06
Kidney international, 2018-04
Kidney Int, 2010 Feb 24
Journal of the American Academy of Dermatology, 2011-05
Clin Exp Rheumatol, 2013 Aug 02
J Rheumatol, 2022 Aug 01
Journal of clinical pharmacology, 2011-08
Transpl Int, 2014 Aug 22
J Clin Med, 2021 Feb 09
Lancet Oncol, 2019 Jan
Arthritis Care Res (Hoboken), 2022 Aug 04
JAMA dermatology, 2018-10-01
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Archives of dermatology, 2002 Sep
The New England journal of medicine, 2019-01-24
N Engl J Med, 2022 Dec 22
Arthritis and rheumatism, 2009-09-15
Lupus, 2020 Apr 11
J Rheumatol, 2009 Oct 15
ACR Open Rheumatol, 2022 Nov
J Rheumatol, 2009 Jan 22
PLoS One, 2022 Oct 10
Front Immunol, 2022 May 26
Rheum Dis Clin North Am, 2022 Feb
Lupus Sci Med, 2021 Jan
Arthritis Care Res (Hoboken), 2020 Aug 19
Ann Rheum Dis, 2021 Dec 15
Lupus Sci Med, 2021 Apr
Arthritis Res Ther, 2006
Adv Biomed Res, 2016 Aug 30
Lupus, 2022 Mar 25
Rheumatology (Oxford, England), 2018-09-01
J Manag Care Spec Pharm, 2022 Jul 01
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Front Immunol, 2021 May 27
Chest, 2021 Feb
Expert review of clinical immunology, 2015 Dec 22
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Rheumatology (Oxford), 2022 Nov 02
Rheumatic diseases clinics of North America, 2021 Feb 25
Lupus science & medicine, 2023 Jan
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J Clin Rheumatol, 2021 Dec 01
Am J Med, 1984 Mar 30
Lupus, 2007
Autoimmun Rev, 2022 Aug 24
Rheumatology (Oxford, England), 2002-08
Int Arch Allergy Immunol, 2010 Apr 22
N Engl J Med, 2003 Oct 23
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Presse Med, 2006 Jul-Aug
Arthritis Rheum, 2004 Oct
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J Rheumatol, 2020 Apr 01
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BMC Rheumatol, 2021 Oct 01
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Front Immunol, 2019 Mar 06
Cell Physiol Biochem, 2017 Nov 14
Clin Cancer Res, 2014 Jun 15
Journal of immunology (Baltimore, Md. : 1950), 2004-08-15
Arthritis care & research, 2019-01
Lupus, 2018-08
Arthritis Rheumatol, 2014 Sep
Arthritis Care Res (Hoboken), 2012 Apr
Lupus, 2022 Jan 23
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Arthritis Rheumatol, 2020 Apr 01
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Arch Dermatol, 2006 Mar
Clin Rev Allergy Immunol, 2010 Apr
Lupus, 2020 Mar 19
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Lupus, 2022 Nov 30
Arthritis and rheumatism, 2009-11
Rheumatology (Oxford), 2014 Oct 21
Cureus, 2019 Aug 19
J Rheumatol, 2007 Sep 15
Rheumatol Int, 2007 Jul 20
Lupus, 2017 Feb 26
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2017 Mar-Apr
Clinical journal of the American Society of Nephrology : CJASN, 2017 May 04
Seminars in arthritis and rheumatism, 2016 Sep 21
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Nature communications, 2021 Jun 07
Lancet (London, England), 2023 Feb 24
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Clinical and experimental dermatology, 2021 Mar 09
JAAD case reports, 2019 Mar 01
Dermatologic therapy, 2020 May 03
BMC nephrology, 2019 Oct 31
Rheumatology international, 2011 Feb 23
Arthritis & rheumatology (Hoboken, N.J.), 2023 Jun 01
Arthritis care & research, 2016 Jan
Lupus, 2014 Feb 06
Lupus, 2019-05
Journal of the American Academy of Dermatology, 2020 Apr 28
The British journal of dermatology, 2003 Jul
Lupus, 2018 Oct 05
Journal of the American Academy of Dermatology, 2017 Oct 06
Annals of the rheumatic diseases, 2023 Oct 12
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2013 Jun 19
Clinical journal of the American Society of Nephrology : CJASN, 2020 Mar 09
Kidney international, 2021 Apr 18
The New England journal of medicine, 2022 Nov 04
Lupus science & medicine, 2020 Feb 18
Lupus science & medicine, 2023 Nov 22
Arthritis research & therapy, 2020 Sep 25
Autoimmunity reviews, 2017 Feb 13
Thrombosis research, 2023 Feb 10
Lupus, 2017 Mar 29
Lupus Sci Med, 2018
Clinical journal of the American Society of Nephrology : CJASN, 2017-05-08
Arthritis & rheumatology (Hoboken, N.J.), 2023 Jun 25
Modern rheumatology, 2020 Jun 16
Arthritis care & research, 2023 Nov 28
Current opinion in rheumatology, 2014-03
Rheumatology (Oxford, England), 2013 Feb 04
Arthritis Rheumatol, 2020 Aug 4
Trials, 2022 Nov 12
Annals of internal medicine, 2021 Oct 26
Arthritis care & research, 2019 Jun
Annals of the rheumatic diseases, 2021 Oct 06
Lupus, 2020 Oct 20
Cureus, 2023 May 10
Clinical journal of the American Society of Nephrology : CJASN, 2009 Mar 04
Lupus, 2024 Jan 16
Arthritis care & research, 2022 Feb 08
Rheumatic diseases clinics of North America, 2006 Feb
The New England journal of medicine, 1986 Mar 06
BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 2003
Therapeutic drug monitoring, 2022 Jun 01
Clinical rheumatology, 2015-08
The British journal of ophthalmology, 1997 Feb
Journal of the American Academy of Dermatology, 2015 Jan 30
Journal of the European Academy of Dermatology and Venereology : JEADV, 2016 Dec 20
Lupus, 2024 Apr 09
The New England journal of medicine, 2005-12-15
Arthritis care & research, 2022 Jun 19
Clinical transplantation, 2020 Nov 22
Seminars in immunology, 2019 Nov 09
ACR open rheumatology, 2024 Sep 13