A 60-year-old man returns for a follow-up related to his diagnoses of rheumatoid arthritis and chronic gout of his right ankle and foot, without tophi. He reports the gout flares have subsided in his ankle. He takes 450 mg of allopurinol daily. He has rheumatoid factor-positive rheumatoid arthritis, which previously affected multiple sites, without organ…
Coding Corner Answer: Use Level 3 or 4 for RA/Gout Patient?
Take the challenge. CPT: 20611-LT, J7325-EJ ICD-10: M17.12, E66.01, Z68.41 CPT: 99213 ICD-10: M1a.0710, M05.79 History—The history of present illness was extended. The review of systems was extended, and two past family social history elements were documented. This makes the history level detailed. Examination—Five systems were examined. This makes the exam level detailed. Medical decision…
Rheumatoid Arthritis Risk Lower Among Smokers Who Quit
(Reuters Health)—Adults who quit smoking decades ago may have a lower risk of rheumatoid arthritis (RA) than people who gave up cigarettes more recently, a U.S. study suggests. Smoking has long been linked to an increased risk of RA, and quitting can reduce this risk. But the new study offers fresh evidence that years of…
Extracellular Vesicles May Play an Important Role in Seropositive RA Disease Severity
In a study, researchers found extracellular vesicles may contribute to the greater disease severity typically seen in patients with seropositive rheumatoid arthritis (RA). Specifically, in these patients, extracellular vesicles can activate mononuclear phagocytes and induce proinflammatory cytokines in vitro…
The Effects of Early RA Treatment on CVD
New research exploring the effects of etanercept on cardiovascular disease in treatment-naive, early RA patients suggests a treatment advantage with etanercept, a TNF inhibitor and methotrexate over treatment with methotrexate and a conventional synthetic disease-modifying anti-rheumatic drug…
The Latest Data on Cancer Immunotherapy’s Interaction with Autoimmunity
CHICAGO—The body of literature on immunosuppressive drugs used to treat cancer and autoimmune diseases is growing, helping bring some clarity to their effects on the immune system and how well they work in patients. This has helped refine the questions that further research must answer, said an expert at the 2018 ACR/ARHP Annual Meeting. The…
The Tortured Path to the Cortisone Discovery
CHICAGO—The path to the discovery of cortisone—a top-selling, important drug, with dozens of indications—was complicated by failure, false moves, desperation and obsession. The tale, recounted in the Philip Hench, MD, Memorial Lecture: Crossroads of History & Hope: Discovery & First Use of Cortisone for RA at the 2018 ACR/ARHP Annual Meeting in October, is an…
Why & How Our Biologic Drug Discussion with Patients Should Evolve
As we turn the corner on the second decade of biologic use for rheumatic disorders, a reappraisal of approach in our communication with patients is due. In practice, the impact these agents have on patients’ lives justifies the friction rheumatologists face when connecting patients to them. You can understand why older rheumatologists who apprenticed on…
B Cell-Directed Therapy May Delay RA Development in High-Risk Patients
New evidence from a clinical trial of rituximab has identified the pathogenetic role of B cells in the earliest, pre-arthritis stage of autoantibody-positive RA…
RA Effectiveness Differs Among Non-TNF Inhibitors
NEW YORK (Reuters Health)—Rheumatoid arthritis (RA) outcomes are better with some non-TNF inhibitors than with others, according to French registry data. “Previously, indirect comparisons (meta-analyses) did not show any difference between biologics in terms of effectiveness,” Dr. Jacques-Eric Gottenberg from Strasbourg University Hospital, France, tells Reuters Health by email. “Our direct comparison using observational data…
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