Antiphospholipid syndrome (APS) is an autoimmune clotting disorder that may present catastrophically with multiple thromboses over a short period of time. In this article, we examine the case of a woman with undiagnosed APS whose first symptoms presented during a long-haul flight. A review of the literature on thrombosis at high altitudes and during long…
You can purchase a dog clicker for about $3 on Amazon. If you don’t own a dog, this is not a useful piece of information. I don’t own a dog, and the first time I heard the phrase dog clicker, I thought—I think understandably—that it was some sort of remote control. If you don’t own…
The 11th annual Investigators’ Meeting and the Rheumatology Research Workshop, held in June in San Francisco, were by all accounts great successes. California sunshine greeted more than 120 attendees as we came together to share the latest advances and updates in rheumatology research. These annual meetings have something for every research professional, whether you work…
In 1982, the ACR developed classification criteria for the identification of systemic lupus erythematosus (SLE) for use in research. The ACR updated these criteria in 1997, and in 2012, the Systemic Lupus International Collaborating Clinics (SLICC) group developed an additional set of classification criteria. In 2014, in an attempt to establish and refine even more…
Can principles from engineering provide a broader understanding of how the human skeleton works and be used to help prevent a common and often consequential event for people as they age—bone fractures? Research from a team of investigators that includes orthopedic surgeons and mechanical engineers suggests that, yes, looking at how engineered materials, such as…
The immune system is an ocean, wide, vast and unfathomably deep, over which we rheumatologists traverse. Beyond the ripples, waves and eddies on the surface, we can only imagine what lies under the surface. With new information from basic laboratory studies and the incorporation of immunomodulators into clinical practice, we have some new insight into…
Based on the classification system developed by the Chapel Hill Consensus Conference, anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is defined as a necrotizing vasculitis involving small vessels that is associated with myeloperoxidase (MPO) ANCA or proteinase 3 (PR3) ANCA and displays minimal immune deposits. The mechanism behind the pathogenesis of ANCA-associated vasculitis is not fully…
Evidence is accumulating that the microbiome may be an important part of the pathogenesis of many autoimmune diseases. Two recently published articles report on how translocation of the gut bacterium Enterococcus gallinarum drives autoimmunity in mice and humans, and on the role of other commensal bacteria in triggering immune responses—specifically to the autoantigen Ro60, which…
For patients with refractory Takayasu arteritis (TAK), glucocorticoids (GCs) are often provided as the initial therapy for treatment. However, GCs are often associated with adverse effects for long-term use; relapse also occurs frequently during GC tapering.1 TAK involves interleukin (IL) 6. Tocilizumab—a recombinant, humanized, anti-IL-6 receptor (IL-6R) monoclonal antibody—was first reported by Nishimoto et al….
Down syndrome (trisomy 21) is one of the most common chromosomal abnormalities. According to the Genomic Resource Centre of the World Health Organization, each year 3,000–5,000 children are born with this chromosome disorder, and about 250,000 families have at least one member with Down syndrome in the U.S. Down syndrome is caused by numerical aneuploidy,…
Rheumatologists and orthopedic surgeons must frequently collaborate to provide optimal patient care. Sometimes, they may even work at the same practice and form a care team for easy collaboration. Still, patient management from both specialties can be challenging, and specialists from both sides can learn from each other. How Crossover Starts Rheumatologists and orthopedic surgeons…
“You have systemic sclerosis,” says the physician. Other somber words patients may hear the day they learn their diagnosis include, “rare, chronic, no treatment.” But a ray of hope could soon enter those exam rooms thanks to research conducted by a team from the UK. Rizgar A. Mageed, PhD, FRCP, FRCPath, is professor of experimental…
In 2005, a workforce study conducted by the ACR projected a shortage of 2,500 rheumatologists by 2025.1 This resulted in an increase in the number of rheumatology fellows trained and the development of online training programs for nurse practitioners and physician assistants in rheumatology. In 2014, Daniel Battafarano, DO, MACP, was a member of the…
Like other areas of medicine, rheumatology is facing a significant workforce shortage. As documented in a recently published study by the ACR, the demand for rheumatology clinical services is expected to exceed the supply of rheumatology providers by 2030.1 Without a concerted effort to explore ways to retain rheumatology providers in the workforce, this imbalance…
A new biologic agent for treatment of systemic lupus erythematosus (SLE) being tested in clinical trials is showing promise as a safe and effective new treatment, particularly in patients with more severe disease or serologically active disease. Recently published results of a study that examined the safety and efficacy of atacicept for SLE showed the…
Researchers in Demark studied joints of young adult athletes to better understand the difference in bone marrow edema common in healthy people vs. what is experienced by patients with spondyloarthritis, a serious inflammatory condition of the spine and sacroiliac joints. Early recognition of spondylo-arthritis can be tricky because it can be confused with symptoms and…
AMSTERDAM—As more biosimilar drugs for rheumatic diseases make their way to market, evidence is growing that switching from the originator drug to a biosimilar tends to be effective, while the questions of switching back and forth, and switching multiple times using several different biosimilars, remain to be answered, an expert on the topic said at…
AMSTERDAM—Molecular signatures in synovial tissue that can be gathered through biopsies are a largely untapped resource that could help guide treatment for rheumatic conditions, an expert said at the EULAR: Annual European Congress of Rheumatology. “I’m convinced that looking into synovial tissue provides us with tools to not only understand mechanisms of disease in rheumatoid…
Growing up in Iowa, Christine Thorburn, MD, loved to run track and cross-country and dreamed of one day being an Olympic runner. Little did the future rheumatologist know that a knee injury would cause her to change course and become a professional road cyclist who would represent the U.S. in two Olympic Games. Dr. Thorburn…
In a long-term extension study, belimumab proved safe, demonstrating low organ damage accrual in SLE patients treated for up to nine years…
In its first phase 3 clinical trial, intravenous tramadol has met its primary endpoint for relieving postoperative pain…
Medical students and residents are choosing careers in rheumatology, thanks to an annual event hosted by the Rheumatology Research Foundation during the ACR/ARHP Annual Meeting. The Choose Rheumatology Experience, formerly known as the Student and Resident Experience, is a daylong event designed to help future physicians and health professionals navigate the Annual Meeting. Cultivating interest…
On Sept. 23–25, the ACR will once again hold its annual Advocates for Arthritis fly-in event in Washington, D.C. Held in conjunction with the ACR’s Advocacy 101 course, the fly-in is a great way for members and their patients to learn about issues important to the practice of rheumatology and have the opportunity to actively…
It’s time to submit your most outstanding emerging studies. The late-breaking abstract category allows for the submission of truly late-breaking, high-impact scientific research for which no preliminary data were available at the time of the June 5 general abstract submission deadline. Late-breaking abstracts should present data that are high impact, groundbreaking, innovative and newsworthy. Late-breaking…
While African-Americans and Hispanics—especially women in these ethnic groups—are disproportionately affected by lupus, they are under-represented in clinical trials in lupus and other chronic diseases.1,2 With the help of a new federal grant, the ACR took the first step to address this lack of diversity in lupus trials this year. The ACR’s Collaboration Initiatives (COIN)…
Before the ACR/ARHP Annual Meeting gets started in Chicago in October, the ACR’s pre-meeting practice management and coding courses offer an intensive educational opportunity. The Oct. 19–20 sessions, ACR Coding Course: Unlock the Mysteries of Advanced Coding for Rheumatology and Practice Management: Putting the Pieces Together—Winning Strategies for Rheumatology Practices, are the industry’s premier events…
Scenario 1 History: A 45-year-old male patient with sero-negative rheumatoid arthritis affecting multiple sites, but with no organ or systems involvement, comes for a follow-up visit. The patient reports swelling of the left knee with throbbing left knee pain. He rates the severity of his pain at an 8 on a 10-point scale. The pain…
Take the challenge. Scenario 1 is the correct answer. Although documentation of both scenarios supports a Level 4 visit, only one supports the medical necessity to code an evaluation and management (E/M) visit on the same day with a procedure. Scenario 1 supports the need for a separate E/M visit, because a new problem was…