What struck me first as I walked by the exam room where Lynn P. sat was the swelling in her fingers and wrists. The bloated hands rested unnaturally on her thighs, palms up, fingers slightly flexed. Her strawberry-blond curls were offset by a high-neck, loose-fitting, burgundy sweater. Her pale skin matched her trim slacks. She had…
A website provides visitors with a first glimpse of your practice. “Whether you like it or not, people will learn about you and judge you based on your website,” says David Borenstein, MD, MACR, MACP, rheumatologist and partner, Arthritis and Rheumatism Associates, and clinical professor of medicine, Division of Rheumatology, Department of Medicine, The George…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis (p. 63). Before you turn to the discussion, examine these images carefully and draw your own conclusions. History For the discussion, click here. A 55-year-old man on…
View the question. Findings/Diagnosis The AP radiograph of the left hip (see Figure 1) shows periarticular, well-defined erosions of the left hip (white arrow) without joint space narrowing or osteophytes. There is no fracture. There are surgical clips and a calcified mass in the right hemipelvis (black ellipsis), representing a failed renal transplant. The coronal STIR…
Etanercept Biosimilars A number of Phase 3 trials are ongoing for etanercept biosimilars.1 One evaluation identified three trials in rheumatoid arthritis (RA) patients and one in psoriasis patients. The psoriatic arthritis trial evaluated PASI as a primary endpoint and the following secondary endpoints: PASI50, PASI75, PASI90, PASI score, laboratory values, ECG, adverse events (AEs), injection…
The only way to be confident your practice is performing well is to conduct periodic internal reviews of your practice operations. This allows you to familiarize yourself with the intimate details of your practice operations and identify what you are doing well and what needs improvement. Doing so will not only help your practice become…
It takes adjustment and patience. That sounds like rheumatology. But for Fred Murphy, DO, FACP, FACR, it also defines his other career—drink inventor. From a drink for the whole family to another he claims helps hangovers, creating beverages is a challenge he relishes. “It’s fun to see what I can come up with next,” he…
ROME, Italy—Even with classification criteria that have been updated and refined over time, rheumatoid arthritis is still a diagnosis that ultimately has to be made with clinical judgment, said Ronald van Vollenhoven, MD, PhD, professor of medicine and chief of clinical therapy research in inflammatory diseases at the Karolinska University in Sweden. His remarks came…
ROME, Italy—Fatigue, a problem experienced frequently by patients with rheumatic diseases, is best thought of as a survival mechanism and as a single phenomenon, not a condition that comes in a variety of forms, an expert said in a session at EULAR 2015, the annual congress of the European League Against Rheumatism (EULAR). Gene Regulated…
A growing understanding of the immunomodulatory effect of the autonomic nervous system (ANS) is edging closer to having clinical applications that could one day benefit patients with rheumatoid arthritis (RA). Researchers pursuing this as an alternative path to biomarkers are investigating whether autonomic status can be used to predict response to therapy. Seattle-area rheumatologist and…
Over the years, cell phones have evolved from purse-size behemoths to the size of a wristwatch. In addition, they have moved from basically a portable telephone to the smartphones of today. Both the changes in size and the added functions have resulted in new concerns for physicians. “We had a family meeting about two years…
A healthy 30-year-old Indian male was performing his routine workout in the gym when he developed giddiness and transient blackouts. He thought it was due to exercising excessively. Over the next month, he developed a low-grade fever and started feeling lethargic, to the extent that he was unable to exercise or work. He was admitted…
Antiphospholipid syndrome (APS) is an autoimmune condition characterized by hypercoagulability often manifested as recurrent thrombosis or pregnancy complications, with persistently circulating antiphospholipid (aPL) antibodies or lupus anticoagulant. Catastrophic APS (CAPS), also known as Asherson syndrome, occurs in less than 1% of cases of APS and involves occlusive microangiopathy in at least three organ systems.1 Case…
In the past decade, there has been a clear demand for and a significant increase in online learning. This was clearly documented in the 2013 report, Changing Course: Ten Years of Tracking Online Education in the United States.1 The report finding demonstrated that 6.7 million students were taking at least one online course, a marked…
All practices share a basic need for infrastructure and governance, because this has direct implications on success. Regardless of the type of practice or location, there should be processes in place to monitor the execution of the entire business operation. Although not everyone in the practice will need to be proficient in this area, it’s…
CPT code: 99214 Diagnosis: ICD-9 274.02 **ICD-10: M1A.0720 History—The history of present illness was extended. The review of systems was extended (six systems were reviewed), and two of the three elements for past family social history were documented. This makes the history level detailed. Examination—Three systems were examined. This makes the exam expanded problem focused….
Each year in August, lawmakers return home for the summer recess and convene district workweeks. That means you have the opportunity to meet with members in their local offices, attend fund-raisers nearby or participate in a town hall. This is where our strength as a membership organization can benefit us most. We have real physicians…
Turn your great idea into a great meeting! Submit your session or study group proposal for the 2016 ACR/ARHP Annual Meeting, to be held Nov. 11–16, 2016, in Washington, D.C. We are looking for ideas that reflect clinical innovation and cutting-edge research, convey best practices, present evidence-based medicine and stimulate discussion to challenge mindsets. When developing your…
We all know that completely different medical conditions can create the same effects on our patients’ work lives. That is, from the employer’s purely administrative standpoint, an absence is an absence regardless of its cause. Even medical care professionals react differently to similar effects rendered by completely different circumstances. A Personnel Crisis Let me give…
The Friday night press release: When a politician or any public figure needs to disclose unfavorable news, chances are they will release it sometime on a late Friday afternoon or evening, hoping that nobody is paying attention. In fact, this behavior was coined “the take out the trash day” on the television political drama, The…
William Robinson, MD, PhD, first became interested in rheumatology in medical school when he started working with a rheumatologist, as well as several other rheumatology mentors. After completing his residency, he joined the rheumatology fellowship program at Stanford University Medical Center, Palo Alto, Calif., where he earned support for his research from the Rheumatology Research…
The Lupus Initiative (TLI) has been an emergent creation inside the American College of Rheumatology (ACR) for the past six years. In 2009, the Office of Minority Health and Office of Women’s Health (now called the Office of Health Disparities) solicited an application from the ACR to develop resources for educating non-rheumatologists, both in training…
About a year ago, I stuffed all my earthly belongings into my black Volkswagen Jetta and set out on a 10-hour interstate journey. I had just graduated from residency at the University of Kentucky and was headed westward, to Iowa City, for a fresh start as a rheumatology fellow. During the 10 hours I spent…
Follow-up Visit with Time A 62-year-old male patient returns to the office for a follow-up visit for chronic idiopathic gout without tophi. The patient’s present uric acid level is 4.0, and he is now taking allopurinol 450 mg per day. Previously, he was taken off indapamide due to an increase in his uric acid. He…