An Initiative to Improve Timely Glucocorticoid Tapering in Vasculitis.

Background/objective: High-dose glucocorticoids (GCs) are required in the initial treatment of systemic vasculitis. However, slow or delayed tapering can lead to unnecessary GC exposure and toxicity. In this quality improvement initiative, we aimed to increase appropriate GC tapering among newly referred patients awaiting specialty consultation at a tertiary vasculitis clinic.

Missed hypereosinophilic syndrome in a critically ill patient with systemic lupus erythematosus.

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden.

Orbital myositis in systemic lupus erythematosus: A case report and literature review.

Orbital myositis is a rare manifestation of systemic lupus erythematosus (SLE). Herein, we report a case of orbital myositis in a patient with SLE, along with a literature review. A 45-year-old female patient presented with pain in the right eye, chemosis, proptosis, and limited abduction.

Frequency of repeat antinuclear antibody testing in Ontario: a population-based descriptive study.

Background: Repeat antinuclear antibody (ANA) testing may be unnecessary, potentially harmful and costly. Our aim was to assess the frequency and correlates of repeat ANA testing in Ontario.

Methods: We performed a retrospective descriptive study identifying ANA tests performed over 2008-2015 among adults within the Ontario Laboratories Information System.

Headache and vision changes in an elderly man with rheumatoid arthritis.

We present a case of an elderly, immunosuppressed patient with rheumatoid arthritis who was not appropriately vaccinated, and subsequently developed herpes zoster ophthalmicus, which initially presented similar to giant cell arteritis. Evidence-based vaccinations are integral in decreasing the incidence of preventable diseases and promoting optimal health at the individual and population level. Although the patient ultimately did not suffer any long-term adverse sequelae, this case highlights the importance of vaccination in the rheumatology setting, and to consider both inflammatory and infectious causes of headache and vision changes in the elderly.

Online virtual cases to teach resource stewardship.

Background: As health care costs rise, medical education must focus on high-value clinical decision making. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed to simulate real patient encounters to increase price transparency and reinforce cost consciousness. To teach and assess efficient resource use in rheumatology, online virtual interactive cases (VICs) were developed METHODS: The VIC modules were distributed to a sample of medical students and internal medicine residents, who were required to assess patients, order appropriate investigations, develop differential diagnoses and formulate management plans.