11 Principles in the Management of Patients with Rheumatic Disease

Question 1

This should be the cornerstone of care for children with rheumatic disease

Answer 1

Expertise

Question 2

First step in the care for children with rheumatic disease

Answer 2

Accurate diagnosis

Question 3

T/F Team care is required for every child with a rheumatic disease

Answer 3

F, expensive and NOT required but should be available when needed

Question 4

T/F A child with a rheumatic disease should be encouraged to be as physically active as possible

Answer 4

T

Question 5

T/F There are currently no specific evidence-based dietary recommendations for the treatment of rheumatic diseases

Answer 5

T

Question 6

Evidence-based advice for supplementation in rheumatic disease should include

Answer 6

1) Calcium + vitamin D particularly for children on GC
2) Folic acid for children on MTX
3) Supplemental iron with or w/o vitamin C for children with anemia of chronic illness

Question 7

T/F Children with rheumatic disease on chronic GC are at risk for atherosclerosis

Answer 7

T

Question 8

T/F Children with chronic inflammatory diseases are at increased risk for dyslipidemia and CV disease

Answer 8

T

Question 9

T/F Immunization may exacerbate or initiate rheumatic disease

Answer 9

F

Question 10

Nonlive vaccines appear to be safe in children with rheumatic disease while using GC at a dose of

Answer 10

≤2mkday

Question 11

Nonlive vaccines appear to be safe in children with rheumatic disease while using MTX at a dose of

Answer 11

≤25mkweek

Question 12

T/F Nonlive vaccines appear to be safe in children on DMARDs and biologics

Answer 12

T

Question 13

Immunogenicity of vaccines has been shown to be appropriate despite reduced responses when on MTX at a dose of

Answer 13

> 15mkweek

Question 14

Immunogenicity of vaccines has been shown to be appropriate despite reduced responses when on GC at a dose of

Answer 14

> 2mkday

Question 15

___ (3) have been shown to greatly reduce responses to vaccines

Answer 15

Rituximab
Cyclophosphamide
Azathioprine

Question 16

T/F TNF inhibitors have been shown to reduce immunogenicity of vaccines

Answer 16

F

Question 17

Live attenuated vaccines are recommended for children with rheumatic disease unless on

Answer 17

1) High-dose DMARDs
2) High-dose GC
3) Biological agents

Question 18

T/F Children with severe, active rheumatic disease should defer immunization until the disease is at a more stable, less active, or inactive state

Answer 18

T

Question 19

T/F Ideally, antibody level against VZV should be known before start of immunosuppressive therapy

Answer 19

T

Question 20

Varicella vaccine is generally contraindicated among patients on what medication/s

Answer 20

GC at 2mkday pred or its equivalent to a total of 20mg/day of pred or its equivalent in children who weigh >10kg taken for longer than 14 days

Question 21

This medication should NOT be used for at least 6 weeks after varicella vaccination

Answer 21

Salicylate

Question 22

Recommended for children on immunuppressives who test negative for varicella antibody

Answer 22

Immunize with varicella vaccine 3 week before starting therapy

Question 23

Recommended for children on immunoppressives exposed to varicella

Answer 23

Receive VZV Ig within 72h after exposure

Question 24

Recommended for children on immunosuppressives who develop chickenpox

Answer 24

Give oral or parenteral Acyclovir, stop immunosuppresive temporarily BUT continue GC

Question 25

Recommendation re: live vaccine for children on immunosuppressive therapy

Answer 25

Should not receive any live virus or bacterial vaccines; once immunosuppressives are stopped, live vaccines may be given after a minimum of 3 months

Question 26

Risk for opportunistic infections and varicella among children on immunosuppressives appear most commonly with use of what biologic agent

Answer 26

Anti-TNF

Question 27

Prior to initiation of anti-TNF therapy, patients should be screened for

Answer 27

Latent Tb and Hep B immunity

Question 28

The effectiveness of live vaccines may decrease if administered ___ prior to IVIg administration

Answer 28

2 weeks

Question 29

MMR and varicella vaccines should be administered ___ after IVIg

Answer 29

8 months

Question 30

If MMR and varicella are administered 14 days prior to IVIg, it is recommended that ___

Answer 30

They should be repeated 8 months after IVIg

Question 31

Transition to adult care is a process that should start when

Answer 31

When a child reaches adolescence