Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
Given that we would delay rituximab treatment for many active infections, I would recommend that we apply the same restrictions. I would hold the rituximab for ten days after covid test confirmation.
When do you consider vascular imaging in patients with Raynaud's and what type of imaging modalities do you utilize?
I typically do not do any vascular imaging studies on patients with Raynaud phenomenon if they have typical symptoms. I do perform nailfold capillaroscopy in patients with new-onset Raynaud to help determine the presence of or risk for future development of connective tissue disease. Studies suggest...
Despite the lack of evidence, do you utilize glucosamine and chondroitin sulfate for osteoarthritis?
There have been numerous placebo-controlled trials and meta-analyses addressing this question over the last couple of decades, most concluding that neither glucosamine, chondroitin sulfate nor the combination provides better symptom relief than placebo (Fransen et al., PMID 24395557, Miller and Cleg...
Would you consider anifrolumab in the management of hematologic manifestations in SLE?
Hematologic manifestations in SLE vary widely from asymptomatic to life-threatening, from cytopenias to severe bleeding to thrombosis to multiorgan failure. Hematologic manifestations can also be compounded by medications, infections, and co-existing conditions. Each of these manifestations is drive...
Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?
Yes, using IL-6 drugs is a good option for the patient with GCA post ICI. I think theoretically we should be able to continue immunotherapy and biologic therapy such as tocilizumab, but we do not have evidence and insurance companies have not been very amenable. The goal of my research is to ensure ...
Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?
Cutaneous reactions from immune checkpoint inhibitors (ICPi) generally fit into 3 categories: rash/inflammatory dermatitis, bullous dermatoses, and severe cutaneous adverse reaction (SCAR). For grade 1-2 rash/inflammatory dermatitis, if symptoms can be managed with topical therapy or non-steroidal o...
What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation. However, I do not agree with this. The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drugs, infe...
What have you found effective for the chronic fatigue that is often seen in patients with SLE or Sjogren's despite overall good disease control?
I am not surprised this question has not been answered yet. This is a tough and common clinical scenario, huh?However, there is a lot we can do for patients. And we can help many of these patients.1. The 1st question out of my mouth to the patient is:"How many hours of sleep do you get per night? Is...
How much weight would you place on a low titer Ku antibody in a patient with mild CPK elevation but no weakness on exam and no other features of CTD overlap syndrome?
Not much as we know autoantibodies can be false positive especially at low titre. I do not treat patients with just autoantibody without any clinical feature. If this patient has anti-Ku antibody with elevated CK, I would just monitor the patient regularly for development of new clinical symptoms/si...
How do you approach differentiating segmental arterial mediolysis from abdominal vasculitis?
This can be quite challenging. Patients with SAM tend not to have increased inflammatory markers to the degree that patients with abdominal vasculitis do. In addition, I rarely have found a SAM patient being systemically ill like we commonly do see patients with systemic vasculitis involving the abd...