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Specific considerations for autoimmune disease patients: Delayed gastric emptying may affect absorption of oral medications, including some immunosuppressants Monitoring challenges in distinguishing disease activity from medication side effects Importance of maintaining stable immunosuppression regimens Patients should seek immediate medical attention for severe, persistent abdominal pain (potential pancreatitis or gallbladder disease), vision changes, severe vomiting/dehydration, neck mass/hoarseness, or allergic reactions

222 Aside from the potential for systemic oxalosis, concern is also warranted because a pro-oxidant effect of high-dose vitamin C, either directly or through its effects on mobilization of iron, has been reported