A new guideline developed by the ACR and the American Association of Hip and Knee Surgeons addresses the perioperative use of antirheumatic drug therapy. Specifically, it provides recommendations on the use of traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib and glucocorticoids in adults with RA; SpA, including ankylosing spondylitis and psoriatic arthritis; JIA; or SLE undergoing elective THA or TKA. The guideline provides recommendations regarding when to continue, when to withhold and when to restart these medications, and the optimal perioperative dosing of glucocorticoids…
Anti-CarP May Play Special Role in RA-Associated Mortality
Researchers may have established a relationship between a new RA autoantibody, anti-carbamylated protein (anti-CarP) antibodies, and increased mortality risk. The recent study showed that anti-CarP was the only autoantibody associated with mortality, specifically respiratory system cause of death…
Soccer, Wrestling among Sports Tied to Risk of Knee Arthritis
(Reuters Health)—Participation in some sports, including soccer, wrestling and elite-level long-distance running, may increase the risk of knee osteoarthritis, researchers say. “While the typical athlete is not at a greater risk of knee osteoarthritis, it was interesting to see that certain athletes may be more likely to have knee osteoarthritis later in life, specifically, elite…
Rheumatology Drug Updates: Uncertain Future for Romosozumab, Plus FDA Approves Tocilizumab for GCA
Romosozumab’s Future Is Uncertain Romosozumab, which has the possible U.S. brand name Evenity, is awaiting approval from the FDA.1 The treatment is an investigational, injectable biologic for treating osteoporosis. It increases bone formation and bone density, reducing a patient’s risk of fractures. The manufacturer no longer expects the FDA to approve the drug this year…
Allopurinol Appears More Renoprotective than Febuxostat in Older Adults
NEW YORK (Reuters Health)—The renal protective effect of allopurinol appears to differ from that of febuxostat in the elderly, according to new research. The study, of a nationally representative sample of Medicare patients, showed that allopurinol was associated with a greater reduction in the risk of incident kidney disease, report the authors online July 13…
Immune Response to Trauma May Flag Impending Organ Failure
NEW YORK (Reuters Health)—Early immune response signatures in the critically injured may shed light on mechanisms underlying multiple organ system failure, according to U.K. investigators. As Dr. Joanna M. Shepherd of Queen Mary University of London tells Reuters Health by email, “Multiple organ dysfunction syndrome (MODS) is common after major trauma and it contributes to…
Rituximab May Help Pediatric Patients with SLE
Although rituximab is not indicated for adults with SLE, a recent review suggests that it may be safe and effective for treating pediatric SLE. The review found that rituximab improved renal function and reduced proteinuria in pediatric patients. It may also prevent relapse and improve disease activity…
Rheumatology Coding Corner Question: Established Patient Office Visit with Acute Gout
A 66-year-old female patient returns to the office complaining of swelling and a burning pain in her right first toe. She rates the pain level at a 9 out of 10. She currently takes an over-the-counter non-steroidal anti-inflammatory drug (NSAID), but it has done little to alleviate the pain. This is her second episode this…
Rheumatology Coding Corner Answer: Established Patient Office Visit with Acute Gout
Take the challenge. CPT: 99214-25, 89060, 20600-RT ICD-10: M10.271, T50.2X5A, I10 This is an established outpatient visit. This encounter is coded as 99213, because it included: History—Detailed: The history of present illness is extended, the review of systems is extended, and the past medical and social histories are documented. Examination—Detailed: Seven organ systems are examined….
Cardiovascular Disease Mortality Risk Remains Higher for Patients with RA
CHICAGO—Sherine E. Gabriel, MD, MSc, professor of medicine at Rutgers Medical School in Newark, N.J., and a past president of the ACR, presented an overview of cardiovascular disease and rheumatology on a Saturday morning to a room overflowing with rheumatologists attending the ACR’s State-of-the-Art Clinical Symposium in April. She noted that physicians have known for a…
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