Rheumatology
Clinical discussions on autoimmune diseases, biologic therapies, vasculitis, and musculoskeletal conditions.
Recent Discussions
What are some strategies to help teach patients transitioning from pediatric to adult care to become more independent with respect to their care and less dependent on their caregivers?
A framework that has been helpful is Got Transition® that provides a structure for the approach in implementing a transition process. It is divided into areas to help health care providers, youth and young adults, parents and caregivers. Numerous resources are available for all stakeholders that inc...
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
Yes, captopril is dialyzable with about ~35% of the drug being removed during intermittent hemodialysis. It is not recommended to be used if an AN69 hemofilter is used for iHD, as it is associated with anaphylaxis with that particular filter. There does not appear to be any contraindications to usi...
What disease activity measures do you find helpful in clinical practice for psoriatic arthritis/peripheral spondyloarthritis?
Treat to target strategy has been shown to improve patient outcomes in patients with PsA (TICOPA study). Therefore, it is important to set treatment targets and measure disease activity in clinical practice in PsA. Measuring disease activity in this disease is, however, challenging due to heterogene...
Should gonadotropin-releasing hormone (GnRH) agonists be offered to all women of reproductive age about to undergo treatment with cyclophosphamide?
I agree with @Dr. First Last's response with a caveat. Ovarian failure is more likely in patients receiving NIH dosing which is 0.5 -1 gram per meter squared of body surface area monthly as opposed to a fixed 500 mg low-dose every 2 weeks. The former in a typical female over six months would be 9 g ...
Any concern for lupus flare in patients undergoing laser hair removal?
Great question - no there is little concern for this because LHR wavelengths are not in the ultraviolet spectrum which is known to spark SLE flares. Even narrow-band UVB (phototherapy) has been used in SLE patients without much issue, however, this is controversial and some feel that depending on th...
How would you manage subclinical ILD associated with MDA-5 Dermatomyositis?
Subclinical ILD in anti-MDA5 is like a time bomb waiting to explode. Would do aggressive monitoring for ILD symptoms/tests and give at least 1st line immunosuppression with CellCept or tacrolimus.
How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?
The data with lupus and RT is not consistent and most recent data suggest good tolerance to breast RT. I have them continue on medication for lupus and counsel them that acute morbidity and late effects appear to similar although there is some chance it may be enhanced but not contraindication to RT...
What is your approach to initial assessment of disease extent in patients with Behcet's disease?
As Behcet's syndrome is a clinical diagnosis, the symptoms that a patient presents with dictates the initial assessment, for the most part. A lot of work up is needed to rule out other conditions that may mimic Behcet's syndrome, however, assuming that has been done, evaluation for eye involvement b...
How important do you feel HLAB51 testing is in diagnosing Behcet's disease?
The diagnosis of Behcet syndrome is based on clinical signs and symptoms. Laboratory testing and imaging studies are usually used to rule out conditions that may mimic Behcet rather than confirm the diagnosis. There is a strong genetic association between HLA-B51 and Behcet. About 50–80% of Behcet p...
What is your first treatment of choice in patients with dermatomyositis sine myositis?
Great question! For better or worse, there isn't a great one-size-fits-all answer since choosing the "best" agent means assessing the severity of the disease, assessing if there are extracutaneous manifestations that also need to be addressed (e.g., interstitial lung disease? inflammatory arthritis?...