SAN FRANCISCO—An athletic 19-year-old male has an episode of rhabdomyolysis, a breakdown of muscle tissue that leads to contents of muscle fiber in the blood, after weight-lifting and basketball drills. But his labs come back normal. He cuts down on his exercise, but has a second episode four months later, then finally sees a rheumatologist…
SAN FRANCISCO—Rheumatologists have to look no further than the American College of Rheumatology guidelines to know that the options for patients with lupus nephritis are sometimes not very appealing. The first-line choices are either mycophenolate mofetil (MMF) plus glucocorticoids or cyclophosphamide (CYC), also with glucocorticoids—and all of their attendant side effects. The problem: evidence, said…
SAN FRANCISCO—A 40-year-old woman shows up in the clinic with scarring alopecia, with an area of hyperpigmentation on the rim of her scalp, extending from just behind the temple to behind her ears. An examination with a dermatoscope shows hyperkeratotic follicular plugging. The case—in this example, the discoid form of cutaneous lupus erythematosus (DLE)—is one…
Currier McEwen, MD, was a truly remarkable rheumatologist, accomplishing more than even the best of us could imagine. He is even more recognized in the horticulture community as a hybridizer of flowers. He was born Osceola Currier McEwen on April Fool’s Day, 1902, in Newark, N.J., and died in 2003, at the age of 101….
SAN FRANCISCO—Post-menopausal women with osteoporosis, previously treated with oral bisphosphonates, had greater increases in bone density when taking denosumab compared with zoledronic acid over a year’s time, according to a study presented at the 2015 ACR/ARHP Annual Meeting. The findings were discussed in the Discovery 2015 plenary session, which focused on new research. In the…
SAN FRANCISCO—Inflammation can be either acute or chronic, and it’s the inflammatory responses that don’t shut down normally, or resolve, that cause tissue damage in rheumatic disease. “Resolution bridges the gap between acute inflammation and adaptive immunity,” said Derek W. Gilroy, PhD, head of the Centre for Clinical Pharmacology and Professor of Immunology at University…
Four years ago, a series of articles in The Rheumatologist talked about the practice of rheumatology in rural settings. Since then, changes have occurred, with the passage of the Affordable Care Act (ACA), differences in reimbursement and the trek toward value-based payment systems. One major concern expressed in the original article was the fact that…
Many rheumatologists chose the profession because they wanted to delve more deeply into rheumatic diseases than internal medicine calls for. “For most, this level of specialization is sufficient and worthy of a lifelong devotion and commitment,” says S. Sam Lim, MD, MPH, associate professor, Medicine and Epidemiology, Emory University School of Medicine, Atlanta. “However, some…
Value is the ratio of quality to cost. The delivery and measurement of healthcare quality, however, is complex. “We first need to understand and define the health outcomes that are important to patients. Then we need to put into place care pathways that will lead to those outcomes, and finally we need mechanisms to measure…
Similar to other healthcare professionals, I have been required to use ICD-10 codes for the past several months. Unfortunately, I have been unable to discern any improvement in my patient care, but perhaps I have not used the codes long enough. Certainly, healthcare administrators and statisticians assure me there are several advantages of ICD-10 over…