Rheumatology

Rheumatoid Arthritis

Questions discussed in this category

What is the role of synovectomy in the diagnosis and management of patients with inflammatory arthritis?

How do you approach selecting biologic therapy vs non-biologic DMARD (such as methotrexate) as initial therapy in patients with new RA diagnosis with significant erosive disease?

4 Answers available

Would you have concerns starting an anti-TNF in RA patients with history of ITP/chronic idiopathic thrombocytopenia?

1 Answer available

How do you approach CV risk assessment in RA patients when RA itself is associated with some degree of increased CV risk at baseline?

Recent articles regarding the use of JAK-Inhibition in RA have suggested to avoid in patients with increased CV risk. However, RA itself is cons...

2 Answers available

What role do you see for JAK inhibitors in RA treatment strategies given the data we now have regarding CV and cancer outcomes?

For example, would it be appropriate to consider JAK inhibitor therapy as preferable to TNF-alpha inhibitor in patients with heart failure with reduce...

4 Answers available

Would you recommend that a patient with stable coronary artery disease and well-controlled RA on a JAK inhibitor continue on their current therapy?

2 Answers available

Do you still plan to offer tofacitinib to RA patients over 65 if they have one or more additional CV risk factors?

2 Answers available

How do you counsel patients regarding the cardiovascular and cancer risks associated with tofacitinib?

2 Answers available

What is the preferred approach to treating poorly-controlled RA in the setting of active hepatitis B undergoing anti-viral therapy?

1 Answer available

How would you approach treating patients with RA refractory to cDMARDs and a prior history of MALT lymphoma?

1 Answer available

How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?

Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR

2 Answers available

Is active rheumatoid arthritis (RA) a contraindication to hypofractionated breast irradiation?

How does a diagnosis of active RA inform your treatment approach for patients with breast cancer, if at all?

4 Answers available

Would you start a TNF-I for seronegative non-erosive RA in a patient with positive ANA and sun sensitivity without other SLE features?

1 Answer available

Do you avoid dupilumab (IL-4 inhibition) for severe asthma in patients already taking a biologic agent for RA?

1 Answer available

What bDMARD would you choose for a patient with RA with high infection risk and inadequate response to cDMARDs?

Infection risk being primarily chronic venous stasis ulcers

1 Answer available

What is your approach to a patient with well-controlled seropositive RA on abatacept who develops melanoma?

Would you change the treatment to rituxan or continue orencia with regular dermatology follow up?

1 Answer available

Would you have any concerns about starting an anti-TNF in RF and anti-CCP positive RA patients who also have high titer ANA?

Is there an increased drug induced lupus risk?

2 Answers available

How would you treat corneal melt (in the absence of peripheral arthritis) in rheumatoid arthritis?

What immunosuppression and dosing do you typically use?

1 Answer available

Do you find 14.3.3 eta or vectra DA helpful in clinical practice?

1 Answer available

How would you approach treatment for fulminant RA-associated ILD?

Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...

1 Answer available

What immunosuppressive agents would be available to patients with a history of melanoma?

Would you use immunosuppression in patients several years after curative treatment for melanoma?

1 Answer available

How would you approach definitive treatment of intermediate-risk prostate cancer with baseline severe (AUA >25) urinary dysfunction and severe rheumatoid arthritis?

Would your answer change for favorable vs unfavorable intermediate risk disease?

1 Answer available

Do you routinely obtain a chest x-ray prior to initiating anti-TNF or other biologic therapy?

Does Quantiferon gold replace the need for baseline chest x-ray screen?

1 Answer available

What was the rationale for abrupt discontinuation of etanercept rather than gradual tapering in the SEAM-RA trial?

The ACR 2021 RA Guidelines suggest the gradual tapering approach is preferable.

2 Answers available

Was the methotrexate dose reduced over time in the combination therapy or methotrexate monotherapy groups in the SEAM-RA trial?

Giving "rescue therapy" to patients in the combination group implies that there is room to escalate to the dose at enrollment.

1 Answer available

Are the results of the SEAM-RA trial generalizable to other TNF inhibitors given the differences in immunogenicity?

Withdrawal of methotrexate may lead to more disease flares and lack of recoverability with other TNF inhibitors.

1 Answer available

Were the patients enrolled in the SEAM-RA trial prior methotrexate monotherapy non-responders?

Usual clinical practice is to add TNFi once methotrexate monotherapy has failed. If this is the case in these patients, it would seem to increase the ...

1 Answer available

Have you seen rheumatoid nodules or RA-ILD in patients with seronegative RA?

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

2 Answers available

How would you treat a poorly controlled seronegative RA patient who is steroid dependent and is on azathioprine for autoimmune hepatitis?

2 Answers available

How long would you treat with antimycobacterials before starting biologic DMARD in a patient with latent TB and active rheumatoid arthritis?

1 Answer available

What is your approach to a patient with rheumatoid arthritis and moderate disease activity on 25 mg of PO methotrexate?

Do you switch to SQ MTX, or is it best to add tx, such as a TNFi?

1 Answer available

What is your approach to monitoring lipids in patients with rheumatic diseases such as RA and SLE and do you have a lower threshold to start lipid lowering agents compared to the general population?

2 Answers available

What are your thoughts on use of 14-3-3 serum levels in rheumatoid arthritis in conjunction with RF and ACPA?

1 Answer available

What is your methotrexate initiation strategy in DMARD-naive RA patients?

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

2 Answers available

What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?

1 Answer available

Is there a role for to the use of transient elastography (FibroScan) to monitor liver fibrosis in rheumatic patients on long-term methotrexate?

1 Answer available

What is your approach to a patient with an isolated positive rheumatoid factor, negative anti-CCP antibody, and no clinical or imaging evidence of rheumatoid arthritis?

3 Answers available

How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?

1 Answer available

How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?

1 Answer available

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

If so, how would positive levels guide your management?

2 Answers available

What is your initial treatment of choice in patients with RA and associated interstitial lung disease?

1 Answer available

How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as anti-TNF alpha therapy?

For example, healthcare workers who require these vaccines for employment

1 Answer available

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

1 Answer available

Would you continue TNFi for inflammatory arthritis if the patient develops a solid organ malignancy while on that therapy?

1 Answer available

Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?

1 Answer available

How would you manage methotrexate therapy in an active rheumatoid arthritis patient undergoing treatment for latent TB with rifampin?

Do you stop methotrexate or adjust the dose?

1 Answer available

How do you approach treatment of rheumatoid arthritis in a patient with an active hematologic malignancy (such as leukemia or lymphoma) after methotrexate failure?

Does your management change if there is renal involvement of the malignancy?

2 Answers available

When would you recommended restarting biologic medications in an active RA patient after treatment with monoclonal antibodies, convalescent plasma or antiviral medications for a COVID-19 infection?

1 Answer available

Do you switch to certolizumab in RA patients who are doing well on other TNFis and planning to become pregnant?

1 Answer available

What is the biologic of choice in a patient with RA and myasthenia gravis?

1 Answer available

How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?

1 Answer available

Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?

5 Answers available

Is a comprehensive physical exam with vital signs warranted for routine follow-up visits in well-controlled uncomplicated RA patients?

Reduced requirements for documentation by CMS in 2021 with respect to billing and coding have raised new questions about what aspects of physician exa...

1 Answer available

Should MTX be avoided in RA patients with asymptomatic lung nodules?

If so, what would be an ideal DMARD in this setting?

1 Answer available

How do you approach patients with overlapping features of PMR and seronegative RA?

1 Answer available

What is the biologic of choice in a patient with RA and history of non-melanoma skin cancer?

2 Answers available

How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?

2 Answers available

Is it appropriate to consider biologic therapy for treatment of RA in a patient with non-small cell lung carcinoma treated with radiation therapy, who has ongoing active synovitis uncontrolled by conventional DMARDs?

1 Answer available