We are sad to report that Dr. Kaplan passed away on Saturday, June 23. We are reposting this story now to celebrate his life.
Case Report: Cardiac Complications in Scleroderma
A 58-year-old African American woman with a past medical history of hypertension (HTN), hyperlipidemia, severe gastroesophageal reflux disease (GERD) and limited cutaneous systemic sclerosis (lcSSc) presented to the emergency department with shortness of breath (SOB) and progressive bilateral lower extremity swelling for three weeks. She denied any chest pain, but endorsed generalized fatigue and dyspnea…
Have We Reached the Limits of Clinical Classification?
There is an old adage that there are two types of people—lumpers and splitters. For some, people are easily categorized into liberal vs. conservative, Democrat vs. Republican, Donald Trump supporter vs. Hillary Clinton supporter. For others, everyone is a snowflake, and what makes us different is much more important than what makes us the same….
RISE Registry Helps ACR Members Successfully Navigate MIPS
Time certainly flies, and 2018 marks the second year that rheumatologists who see Medicare patients are operating under the new Quality Payment Program (QPP) created by the Medicare Access & CHIP Reauthorization Act (MACRA). MACRA repealed the Fee-for-Service model under the Sustainable Growth Rate (SGR) formula and transitioned Medicare reimbursement to a system more overtly…
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
Looking Back on 40 Years with Rheumatoid Arthritis
The year was 1978. I was a newly married, 25-year-old registered nurse working on a medical unit at Mercy Medical Center in Oshkosh, Wis. I began to notice morning stiffness, increasing fatigue, and bilateral heel and ankle pain. Every step hurt as I walked down the halls to care for my patients. My diagnosis was…
Kussmaul, Meier & Polyarteritis Nodosa
In 1866, Adolf Kussmaul, an internist, and Rudolf Maier, a pathologist, published the classic characterization of what eventually became known as polyarteritis nodosa.1 It was the first scientific clinical characterization of a noninfectious vasculitis. As such, it became a paradigmatic point of contrast to other types of vasculitides that were later described. Their description also…
Using Ultrasound to Diagnose Carpal Tunnel Syndrome
Note: Updated May 2, 2018, to correct a link in the reference section. The error was introduced in editing. A 44-year-old Caucasian woman presented to the outpatient rheumatology clinic that had followed her for several years for rheumatoid arthritis. She was compliant with her regimen of hydroxychloroquine, etanercept and salsalate. Her chief complaint was worsening…
Dr. Harry Spiera Retires after 60 Years in Rheumatology
When Harry Spiera, MD, stepped out of the New York University School of Medicine in 1958, rheumatology was in its infancy. Obviously, much has changed for both the physician and the specialty over the 58 years between then and his recent retirement. “Early on, rheumatology was the most clinical of the specialties, because the science…
How & Why Attending Physicians Should Teach in Patient Rooms
No matter where you practice, rheumatology clinics are extremely busy. And in that hustle and bustle we find an uncomfortable jostling of priorities between delivering optimal care for as many patients as possible and upholding education for teachers and learners at all levels. Because salary usually comes from seeing more and more patients, teaching is…
The 75-Year History of PANLAR
The first organization dedicated to fighting rheumatic disease was the International League Against Rheumatism (ILAR), founded in 1928 under the guidance of a Dutch national, Dr. Jan van Breemen. Interest in rheumatology quickly spread throughout the American continent, and the American Association for the Study and Control of Rheumatism met in Cleveland, for what they…
New Study Examines the Physical Activity & Joint Symptom Risk
If you’re a middle-aged woman who makes a New Year’s resolution to work out regularly and you keep that promise for only six months, don’t think that will go far in protecting your joints. Researchers in Australia have homed in on the details of the sustained physical activity required to reduce the risk of joint…
Study Finds Pedometers Reduce Fatigue in RA Patients
For people with rheumatoid arthritis (RA), fatigue can be a debilitating symptom that interferes with daily life and significantly reduces quality of life. Managing fatigue can be difficult; it is linked to disease activity and a host of other conditions that commonly accompany RA, such as depression, sleep problems and obesity. A new study, however,…
Can Certain DMARDs Treat Dementia?
In the complex web of interactions between systemic inflammatory response, rheumatic disease and disease-modifying anti-rheumatic drugs (DMARDs), what is the potential for using rheumatologic therapies to treat other medical conditions linked to inflammation? Some medical researchers have looked at cardiac conditions, and others have examined the overlap with Alzheimer’s disease and other dementias. Positive effects…
New Study Examines Treatment Options for Incomplete Lupus Erythematous
A recent study explored medical concerns for patients who have lupus markers, but fall short of meeting enough criteria for official disease classification. Investigators at the Oklahoma Medical Research Foundation conducted a large study to explore current treatments of patients with incomplete lupus erythematous (ILE) and to compare antibody characteristics to healthy people and patients…
Experts Discuss Proposed Giant Cell Arteritis Risk Tool
A proposed model to predict the risk of giant cell arteritis (GCA) prior to a temporal artery biopsy could help triage patients and guide decision making about the need for biopsy or monitoring (see Figure 1). There’s no specific biomarker for GCA, and GCA can be a “diagnostic conundrum, especially when it presents in an…
Social Media Connects, Informs Rheumatologists
When Paul Sufka, MD, a rheumatologist with HealthPartners Medical Group and Regions Hospital in St. Paul, Minn., wants to connect with his colleagues or keep abreast of the latest rheumatology journal articles, he turns to Twitter. Dr. Sufka is one of many rheumatologists who have found effective ways to incorporate social media into their medical…
Study Finds Newer Gout Drug Poses Risk to Heart Patients
(Reuters Health)—Gout sufferers with major pre-existing heart disease face a higher risk of death if they are treated with the drug febuxostat, a large long-term study has concluded. The risk of death from cardiovascular disease was 34% higher with febuxostat than with allopurinol. When researchers considered deaths from any cause, the risk was 22% higher…
Pathophysiology of Gouty Tophi
In a recent study, researchers examined synovial fluid and non-inflamed tophi from the acutely inflamed joints of patients with gout, finding that monosodium urate (MSU) crystals trigger a distinct physiological NETosis pathway that coats MSU crystals in DNA that persists in tissues as gouty tophi…
Cannabis in Rheumatology Care: A Look at the Latest Research & What Rheumatologists Are Telling Their Patients
As medical and recreational marijuana becomes more accessible, researchers seek creative ways to study the cannabis plant and explore the complexities of the endocannabinoid system in pain relief. Rheumatologists currently face an influx of patients asking if marijuana can help them. Here’s a look at the evolving research on cannabinoids for rheumatologic pain management and how doctors are discussing it with their patients…
Telehealth Is Helping the Underserved
For many uninsured and underinsured patients in Yuba City, Calif., seeing a rheumatologist used to mean taking a day off from work and driving 108 miles, roundtrip, to the University of California Davis Medical Center. That changed this year when patients were offered the option of having a telemedicine consultation with a rheumatologist as part…
Connect Rheumatology: A Conversation with Paul Sufka, MD, ACR Committee on Marketing & Communications Member
The field of rheumatology is advancing fast—alongside communication technologies that generate a massive amount of information. Paul Sufka, MD, a rheumatologist with HealthPartners in St. Paul, Minn., is interested in the ways social media can help him and other rheumatologists stay connected and keep abreast of practice information. “One thing I see people doing too…
The Link Between Takayasu’s Arteritis & Increased Stroke Risk
Approximately 16% of patients diagnosed with Takayasu’s arteritis (TA) experience a stroke. In a recent study, researchers found patients with TA and stroke had higher levels of C-reactive protein at diagnosis…
Report Shows Rituximab May Help Treat MCTD-Associated PAH
Pulmonary arterial hypertension (PAH) in connective tissue disease (CTD) features significant morbidity and mortality. Standard therapies with endothelin receptor antagonists and phosphodiesterase-5 inhibitors have shown some clinical improvement in patients, but these clinical improvements have proved modest when compared with other types of PAH. As our case below suggests, rituximab may show promise as a…
Study Urges Caution with Steroid Injections for Hip Osteoarthritis
For patients with hip osteoarthritis (OA), pain management and maintaining function are primary therapy goals. Current guidelines offer recommendations on nonpharmacologic and pharmacologic approaches to addressing these issues in hip OA. For patients in whom pharmacologic management is considered, the use of intra-articular steroid injections is one option. In its 2012 guidelines (the most current…
Genetics Suggest Adult & Child Arthritis Aren’t So Different
There has long been a wall separating adult rheumatologists from pediatric rheumatologists. A recent review article published in the January edition of Arthritis & Rheumatology (A&R) suggests that genetics, rather than age, may be a better way to categorize forms of primary inflammatory arthritis across the lifespan.1 “Pediatric and adult rheumatologists don’t generally interact that…
New Arthritis Estimates Put Prevalence Numbers Much Higher Than Previously Thought
Arthritis is often associated with retirees, but a new analysis of government data suggests the disease is much more common in young and middle-aged adults than previously believed. Disease prevalence is currently estimated at about 54 million adults, but that number is greatly underestimated, especially among those 64 and younger, according to a study…
Patient Satisfaction Scores—Do They Matter?
You see a patient for the first time to establish care for Sjögren’s disease. She complains of dry eyes, dry mouth and diffuse arthralgias. You do not appreciate any synovitis on physical exam. Of note, you are the fourth rheumatologist she has seen during the past year. Toward the end of the clinic visit, she…
How to Attract Medical Students & Rheumatology Candidates
As the shortage of rheumatologists is expected to worsen, practices and fellowship programs are asking how to attract top talent. Here are tips for how individuals can raise rheumatology’s profile and reach out to med students and new rheumatologists…
Retired Rheumatologist Cruises the Globe
Several years ago, Ed Herzig, MD, and his wife, Andrea (Andi), spent one week on a Smithsonian cruise that traveled along the western part of the Amazon river, the world’s second longest river, which cuts across seven South American countries. They actually swam in the river, fished for piranha and spotted primitive Peruvian river villages….
A Guide to Understanding Physician Compensation Models
Understanding your compensation is critical before you decide to accept a job. In the world of medical practices or groups, however, this understanding is even more essential, because a wide variety of compensation structures for physicians exists. These compensation models can dictate not only what a physician will make in the near future, but also…
Ixekizumab Promising for AS; Plus Certolizumab Pegol Studied for Psoriasis
In a Phase 3 study, ixekizumab proved safe and effective to treat adults with ankylosing spondylitis (AS)…
FDA Update: Possible Heart Risks with Clarithromycin; Apadaz Receives FDA Approval
After reviewing a 10-year study, the FDA cautions that prescribing clarithromycin to patients with heart disease increases the risk of heart problems or death…
Rheumatology Research Foundation & NIH Program Bears Fruit
The Rheumatology Research Foundation has been actively involved with the NIH’s Accelerating Medicines Partnership for Rheumatoid Arthritis and Systemic Lupus Erythematosus (AMP RA/SLE) program, launched in 2014 as a public–private partnership to spur development of new therapeutic options for RA and lupus. Recently, the NIH released new datasets that will help clinical investigators accelerate therapies…
Patients Have No More Skin to Give: Dr. William Harvey Testifies on Rheumatology Issues before Senate Committee
Prior authorization treatment delays, the preferred status conferred on some drugs by pharmacy benefit managers and exorbitant co-payments were among the issues brought before the U.S. Senate Special Committee on Aging on Wednesday, Feb. 7. William F. Harvey, MD, MSc, FACR, a practicing rheumatologist at Tufts Medical Center in Boston and volunteer on the ACR…
Medicare Participation—Do Physicians Have Options?
Physicians have three contractual options when it comes to the Medicare program: participating, non-participating and opting out. Providers should keep the old saying “look before you leap” at the forefront when considering opting in or out of the Medicare program. Since 2001, physician costs have been on the rise, with only minimal increases in reimbursements,…
Rheumatology Coding Corner Question: RA Follow-Up with Imaging
History A 39-year-old woman returns for follow-up for her rheumatoid arthritis. She has positive rheumatoid factor, but no organ or systemic involvement. She has joint swelling and pain in her left hand, right elbow and right knee. Her pain is at an 8 on a 10-point scale. She states the pain is worse in the…
Rheumatology Coding Corner Answer: RA Follow-Up with Imaging
Take the challenge. CPT codes: 99214, 71045, 86580 ICD-10: M05.79, R05, R06.2 History—Detailed: The history of present illness (HPI) was extended; the review of systems (ROS) was extended; and the past medical, family and social history (PFSH) were documented. All three components of the HPI, ROS and PFSH are needed to achieve the detailed history…