Rheumatology

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Questions and Answers - Click on the question to see the answer.

Q:Is it possible for a fetus to develop a fetal intrauterine cerebral infarct (diagnosed after birth by MRI) from an antiphospholipid syndrome (APS) positive mother? She delivered twins at 38 weeks. Both non-identical twins survived, one was normal.
[Lisa R. Sammaritano, MD]

Q:How long is it necessary to treat active SLE with immunosuppressive drugs? Can immunosuppressive therapy be discontinued? If so, when?
[Michael D. Lockshin, MD]

Q:Can TNF inhibitors be used in HIV-positive patients?
[Dee Dee Wu, MD]

Q:Is methotrexate contraindicated in rheumatoid arthritis patients who have evidence of hepatitis B or C? What options are available for such patients if biologic agents are financially out of reach?
[Dee Dee Wu, MD]

Q:Does ANA-negative lupus exist? What other labs are helpful when thinking of this diagnosis, and what if all of them are negative?
[Michael D. Lockshin, MD]

Q:What has been the experience with anti-TNF agents during pregnancy? Should they be discontinued prior to pregnancy and, if so, how far ahead of a planned pregnancy?
[Lisa R. Sammaritano, MD]

Q:When should patients with antiphospholipid antibody be treated with long-term anticoagulation, and how high should the INR be?
[Michael D. Lockshin, MD]

Q:In patients with rheumatoid arthritis who have evidence of hepatitis B or C infection, can TNF-a antagonists or IL-1 antagonists be safely used?
[Dee Dee Wu, MD]

Q:Would a history of optic neuritis be considered a contraindication for TNF-alpha inhibitor therapy? In the few cases of MS-type symptoms in patients on these therapies, have the symptoms reversed when the medications were discontinued?
[Anne R. Bass, MD]

Q:In patients with lupus and osteoporosis, on prednisone, how would you deal with the osteoporosis when they become pregnant? Would your approach be different if they were not on steroids?
[Lisa R. Sammaritano, MD]

Q:Might herbals or other dietary supplements affect antiphospholipid syndrome or clotting risk, especially in patients treated with Coumadin? What about progesterone in postmenopausal patients with APS?
[Michael D. Lockshin, MD]

Q:What are the treatment options in dermatomyositis with and without pulmonary involvement? Which markers are worthwhile ordering in a patient with dermatomyositis with pulmonary symptoms?
[Lawrence J. Kagen, MD]

Q:How should proliferative glomerulonephritis with crescent formation be treated in young women with SLE? Will low-dose pulse cyclophosphamide (Cytoxan) and/or mycophenolate mofetil (CellCept) do the job while preserving fertility?
[Michael D. Lockshin, MD]

Q:Which treatments worsen rheumatoid nodules, and which makes them resolve?
[Stephen A. Paget, MD]

Q:How has the treatment of psoriatic arthritis changed over the last 5 years? Where do you see it going in the next 2 years?
[Michael D. Lockshin, MD]

Q:In RA patients unresponsive to several DMARDs but who are PPD+ although the chest X-ray is negative, how long should INH prophylaxis be maintained before initiating an anti-TNF agent? Is anakinra safe to use in patients with a positive PPD?
[Anne R. Bass, MD]

Q:Is there any difference in the prognosis of SLE patients who are diagnosed and treated early versus late in the disease?
[Michael D. Lockshin, MD]

Q:How do patients respond to support groups such as those at HSS for lupus, rheumatoid arthritis, and myositis? Do patients with mild disease get upset seeing the severe cases?
[Roberta Horton, ACSW]

Q:What is your approach to the treatment of osteoporosis in patients on dialysis and/or with renal insufficiency?
[Linda A. Russell, MD]

Q:When should a digital sympathectomy be considered in patients with Raynaud phenomenon, and what are the benefits and risks of the procedure?
[Arthur Yee, MD, PhD]

Q:What is the differential diagnosis in a patient with anterior thigh pain, persistently elevated CK, positive rheumatoid factor, positive RNA with speckled pattern, and an abnormal but not diagnostic muscle biopsy, including electron microscopy?
[Lawrence Kagen, MD]

Q:What alternatives are available for gout patients who have skin rashes due to allopurinol?
[Theodore R. Fields, MD, FACP]

About Ask the Expert
Our specialists' responses should not be construed as an official second opinion or consultation but, rather, as the type of unofficial hallway consult we so often do with colleagues. Answers are not intended to be a comprehensive description of all the possibilities raised by the question.

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