Rheumatology   

For example, in the setting of cirrhosis incidentally found on imaging.

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...

Do you attempt to taper fully or maintain at a low dose?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect? 

Would you change rituximab maintenance dose or schedule?

Specifically: starting dose, rapidity of up-titration, frequency of lab monitoring, frequency of office visits, and timing of assessment for treatment...

ADVOCATE trial

Muscle disease is quiescent and no other manifestations such as ILD

In the ADVOCATE trial, patients were not re-dosed with rituximab.

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

If so, are there specific patient populations for which you would use this metric?

 If you use both, how do you decide which to use for a particular patient?