How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?  

I would certainly treat the ITP with hematology involvement if necessary but would continue to monitor for lupus or similar CTDs. I have seen patients present with an ITP-like picture for years before lupus declared itself eventually. It may take years. I would also check a UA for proteinuria. This ...

I would engage in “watchful waiting”. Why were one or more ANAs ordered? That answer may be VERY valuable. Treat the ITP if necessary, although at 60,000 the likelihood of bleeding is low. There are other things to do now: monitor the platelet count moving forward. Certainly, check a uri...

I would definitely treat and follow. There is a considerable portion of patients that present with ITP and Sjogren's disease, so I would definitely investigate this diagnosis, even beyond SSA/SSB testing.Sun et al., PMID 37506503

Agree that in most of these occurrences, this turns out to be an initial manifestation of SLE, with usual management of the ITP, but with expectant observation for future lupus manifestations. It is also always prudent to check immunoglobulin levels in new-onset ITP (in the presence or absence of +A...