Pegloticase is a new alternative therapy for patients with severe, refractory gout unresponsive to other urate-lowering agents. The goal of this therapy is to reduce disease burden, tophi size and frequency of flares and to improve quality of life when other treatments have failed. Persistent lowering of plasma uric acid (PUA) to less than 6…
Where can you network with more than 16,000 professionals in the field of rheumatology? Where you can hear about promising research and best practices from industry leaders? How can you find out about new treatments and technologies on the horizon? You guessed it—at the 2016 ACR/ARHP Annual Meeting, to be held Nov. 11–16. As if…
Can We Stay Forever Young? May your heart always be joyful And may your song always be sung May you stay forever young Forever Young —Bob Dylan Beneath the rubric of orphan diseases reside some rare conditions and others that are extraordinarily uncommon. These are the diseases that most physicians either never to get to…
A 52-year-old woman comes to the office complaining of a two-month history of pain and swelling in the small joints of her hands, feet and knees. She says, “Doctor, I’ve been searching the Internet, and I think I have rheumatoid arthritis. I have some questions for you.” The healthcare system in the U.S. is changing…
Look inside the oral cavity of a patient for answers that go beyond what we perceive as the dentist’s domain. So goes the thinking of medical professionals interested in how oral health and bacteria-driven disease, such as periodontitis, may be linked to rheumatic disease, especially rheumatoid arthritis (RA). Bad bacteria that live in the mouth…
The ACR has been at the forefront of helping rheumatologists meet practice demands, including federal reporting requirements. The first registry that helped meet these requirements was the Rheumatology Clinical Registry (RCR), and it facilitated quality reporting, but required manual entry of required data. More recently, ACR has contracted with FIGmd to create a tool that…
Although most systemic juvenile idiopathic arthritis patients don’t develop macrophage activation syndrome (MAS), the approximately 10% who do have this serious complication can experience widespread, massive inflammation, debilitating symptoms and even death. To improve understanding of MAS among physicians and advance efforts to develop effective therapies to treat it, a panel of 28 international pediatric…
When uric acid becomes elevated in the human body, a variety of problems can develop, most notably gout—a painful, inflammatory arthritis caused by uric acid crystal deposition in joints. Chronically elevated uric acid can also lead to painful kidney stones. The majority of patients found to have hyperuricemia, however, never go on to develop gout…
SAN FRANCISCO—Considerable progress has been made in the treatment and management of rheumatoid arthritis (RA) in the past two decades, with rheumatologists now able to manage the effects of this chronic, debilitating condition for most of their patients, according to Ronald van Vollenhoven, MD, director of the Amsterdam Rheumatology and Immunology Center (ARC) in the…
SAN FRANCISCO—In a presentation on advances in the treatment of systemic lupus erythematosus (SLE) at the California Rheumatology Alliance 2016 Medical & Scientific Meeting in May, Maria Dall’Era, MD, director of the Lupus Clinic and Rheumatology Clinical Research Center at the University of California, San Francisco, discussed the range of treatments that have been identified…
SAN FRANCISCO—“We haven’t made a lot of progress in ensuring the early diagnosis of spondyloarthritis,” said Walter Maksymowych, MD, FRCP, professor of medicine in the Division of Rheumatology at the University of Alberta and chief medical officer at CaRE (Canadian Research and Education) Arthritis, both in Edmonton. Speaking at the California Rheumatology Alliance 2016 Medical…
SAN FRANCISCO—The heterogeneity of systemic vasculitis, a set of diseases characterized by inflammation of blood vessel walls, presents rheumatologists with diagnostic and treatment challenges, said Sharon A. Chung, MD, MAS, director of the University of California, San Francisco Vasculitis Clinic, at the California Rheumatology Alliance 2016 Scientific & Medical Meeting in May. She outlined emerging…
CHICAGO—Diagnosing and treating IgA vasculitis—leukocytoclastic vasculitis involving deposits of IgA1 deposits on the walls of small vessels—is rife with uncertainties, outright unknowns and treatment challenges, an expert on the disease said at the ACR’s 2016 State-of-the-Art Clinical Symposium. Alexandra Villa-Forte, MD, MPH, staff physician at Cleveland Clinic’s Center for Vasculitis Care and Research, said IgA…
CHICAGO—Researchers have come to know a great deal about IgG4-related disease in a short amount of time, leading to effective treatments with the prospect for more, an expert said at the 2016 State-of-the-Art Clinical Symposium. “One of the most exciting things for me is how quickly we’ve been able to move in understanding this disease,”…
CHICAGO—Medicine is in the middle of an infectious-disease “revolution” that seems almost destined to lead to prevention through immunization of many diseases, including rheumatic illnesses, that never were previously thought to involve transmissible agents, an infectious disease specialist said in a session at the ACR’s 2016 State-of-the-Art Clinical Symposium. An array of unlikely and fascinating…
Cross Reactions A recent study published online in March in the Annals of the Rheumatic Diseases investigated if the infliximab biosimilar (CT-P13, infliximab-dyyb), which is marketed in Europe as Inflectra and Remsima, can be safely and effectively substituted for infliximab (Remicade).1 Infliximab and its biosimilar are manufactured via the same process. Researchers set out to…
A passion to improve the clinical reasoning skills of future doctors led Maria Dall’Era, MD, associate professor of medicine and director of the University of California San Francisco (UCSF) Lupus Clinic, to create a revolutionary application for smartphones and tablets that could modernize medical education. With funding from the Rheumatology Research Foundation’s Clinician Scholar Educator…
A majority of state legislatures have concluded their work for 2016. The ACR’s state advocacy efforts continued to focus on policy benefiting rheumatologists and patients alike. The two dominant issues this year were biosimilar substitution and step therapy. Biosimilar Substitution Biosimilar substitution remains the most prevalent issue throughout the states. The ACR continues to monitor…
Looking for a reason to attend the 2016 ACR/ARHP Annual Meeting, which will be held Nov. 11–16 in Washington, D.C.? This monumental meeting will offer a variety of sessions on MACRA/MIPS/APMs, Medicare Value-Based Payment Reform programs, auditing, compliance and coding. Particularly, the pre-meeting workshops will provide you with the unique opportunity to dive deep into…
Recognizing that gaps often occur in the transition process for young adults as they transition from pediatric to adult healthcare, in particular for youth with special healthcare needs, the American College of Physicians’ (ACP’s) Council of Subspecialty Societies (CSS), of which the ACR is a member, initiated a project and engaged several medical specialty organizations…
Level 3 Established Patient E&M Visit A 43-year-old patient is seen in the office for a follow-up visit of her RF-positive rheumatoid arthritis and primary osteoarthritis of the left knee. The patient is on sulindac, methotrexate and folic acid. At her last visit, the patient’s methotrexate dose was increased, which has greatly reduced her pain….
Take the challenge. CPT: 99213 Diagnosis Codes: M05.79, M17.12, Z79.1, Z79.899 Rationale to code this encounter as 99213: History—The history of present illness was extended. The review of systems was comprehensive, and two of the three past, family and social history were documented. This makes the history level comprehensive. Eight systems were examined. This makes…