ACR CONVERGENCE 2020—Patients with concurrent rheumatological arthritis (RA) and liver disease or interstitial lung disease or treatment-refractory rheumatoid arthritis pose treatment challenges, according to the panelists of the ACR Convergence 2020’s How I Treat Difficult RA: Panel Session. Each panelist discussed a difficult case and raised questions on how to best treat it.
Joan M. Bathon, MD, chief, Division of Rheumatology, New York Presbyterian Hospital/Columbia University, New York, presented the case of a 65-year-old man found to have RA and interstitial lung disease (ILD) as well as probable heart failure. She raised treatment questions such as whether methotrexate or leflunomide caused or worsened his ILD and whether there was a disease-modifying anti-rheumatic drug that could treat both his ILD and RA.
Josef Smolen, MD, chairman, Division of Rheumatology, Medical University of Vienna, Vienna, discussed several types of patients with difficult-to-treat RA, including those with ILD, chronic infections such as hepatitis B, cardiovascular disease, and those who do not adhere to treatments. With many efficacious drugs available, rheumatologists should switch to other agents when the ones currently used clearly do not work in difficult-to-treat RA patients, Dr. Smolen advises.
Stanley Cohen, MD, co-medical director, Metroplex Clinical Research Center, Dallas, focused on concurrent liver disease with RA, presenting the case of a 64-year-old female patient with symmetrical polyarthritis who was found to have hepatitis B reactivation.
Watch this page for our full report on this session.