Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?
There is little doubt that bronchiolitis obliterans can be a devastating lung disease. Corticosteroids remain the primary anchor therapy, however, virtually all patients will require an additional agent. Rituximab has become the primary choice and there is evidence, though mostly anecdotal, that it ...
How do you approach the management of SSc-ILD in a patient on immune checkpoint therapy?
If the oncologist thinks immune checkpoint inhibitor therapy is the best treatment for the patient's cancer, we try to facilitate this. We obtain baseline pulmonary function tests and CT scans. Repeat every three months while on therapy. Usually, these patients have pulmonary involved also, in parti...
Do you treat fibromyalgia in your practice or do you refer back to PCP after ruling out autoimmune inflammatory pathology?
The problem of managing fibromyalgia has been the topic of numerous Rheumatology National meetings and more after-hours clinic gatherings. The reality centers around your desire to take care of people; clearly, this is a group of patients who need someone to provide care. Rheumatologists are exceedi...
How do you approach screening for inflammatory bowel disease prior to starting IL-17 inhibitors?
IL-17i are now widely used to treat skin psoriasis (PsO), psoriatic arthritis (PsA), and axial spondyloarthritis (SpA). Genetic and epidemiologic studies suggest the coincidence of these diseases and Crohn’s diseases (CD) as they may present concomitantly in the same patient or affect a family membe...
Is there a role for antibody testing to confirm vaccine response for patients on rituximab after COVID-19 vaccination?
It's a great question, but I do not feel that routinely performing COVID antibody testing would help in the management of these patients: We don't know how well most commercial antibody testing correlates with neutralizing antibody/immune-status (esp. if qualitative testing is performed), and I have...
Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?
Classically, calcinosis in dermatomyositis and scleroderma are different with dermatomyositis having more typical sheet-like calcinosis in the muscles whereas in scleroderma it is more typical on the fingers, extensor surfaces of the forearm, olecranon, knee, and shins. However, many sclerodermas al...
What is your methotrexate initiation strategy in DMARD-naive RA patients?
Best final dose is 20 to 25 mg per week, not 15 mg per week. D Furst
How do you approach monitoring of patients found to have a positive anti-dsDNA antibody without other clinical evidence of SLE?
Autoantibodies are typically present for several years before the diagnosis of SLE. The study by Arbuckle et. al of the U.S. Department of Defense Serum Repository showed that ANA was present 3.4 years, and anti-DsDNA antibodies were present 2.2 years before the diagnosis of SLE. These results indic...
How do you approach the treatment of eosinophilic fasciitis refractory to glucocorticoids and methotrexate?
As rheumatologists, we are accustomed to managing people with rare diseases. Eosinophilic fasciitis (EF) ranks among the rarest of the rare, so it is understandable that there are no carefully designed trials assessing the efficacy of the various immune-modulating drugs. Clearly, corticosteroids are...
Are there any specific circumstances when you would consider the use of immunosuppression for DISH?
DISH and SpA are two separate pathological entities that share involvement of the axial skeleton and peripheral entheses. Both diseases cause bone proliferation in the spine and extraspinal entheseal sites, particularly in the later phases of the disease.DISH is characterized by calcification and os...