Anemia is common in patients with systemic rheumatic disease, yet it may not get the attention it deserves. Anemia can result from chronic inflammation, treatment side effects or other disease factors, or it may signal an unrelated condition. Although diagnosis and treatment of anemia are sometimes challenging, clinicians must do their utmost to rigorously investigate…
All rheumatologists have observed the impact of their patients’ mental health status on the long-term treatment of rheumatologic conditions. Depression, anxiety and even loneliness can lead to poor clinical outcomes and nonadherence to treatment, whether the patient is following medication regimens or participating in regular exercise. On the other hand, a patient’s resilience and positive…
Mysterious Ways The juxtaposition of the old and the new was readily evident that busy Wednesday morning. My first patient, a 94-year-old gentleman, Hal, arrived with a precise request. His rheumatologist for the past 40 years had just retired, and he was searching for a doctor with expertise in the use of gold sodium aurothioglucose,…
A number of autoinflammatory syndromes that result from genetic mutations have been described recently. The vast majority occur in children. However, three periodic fever syndromes are important for rheumatologists who treat adults to know about. The goal of this review is to provide a concise description of each condition, and to help the clinician understand…
Following the 2017 ACR/ARHP Annual Meeting when the formal transition in volunteer leadership occurred, my overwhelming thought has been that it is an honor and privilege to serve you as the 81st president of the ACR. Honor stems from the heritage of excellence and progress that defines this organization. Privilege comes from the opportunity to…
For the last 20 years, Philip Seo, MD MHS, has trained, worked and conducted research at Johns Hopkins University. As an associate professor of medicine, he also serves in two other roles: as the director of the university’s fellowship training program and director of its vasculitis center. After graduating medical school from Columbia University in…
SAN DIEGO—At the 2017 ACR/ARHP Annual Meeting in San Diego last month, the ACR and the ARHP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education and patient care. This month, The Rheumatologist speaks with the ACR winners about their individual contributions to advancing rheumatology. In coming issues, we…
All day, technology dings and beeps, phones buzz, staff members need just a moment of your time, and personal issues linger in the back of your mind. With all of the interruptions and potential distractions that occur throughout a day, how do rheumatologists stay focused on patient encounters and work responsibilities? “Arriving at work early…
According to a large cohort study of pediatric patients, rituximab use is on the rise in the treatment of children diagnosed with vasculitis. Treatment with cyclophosphamide remains common, but it’s beginning to wane. Dialysis and mechanical ventilation also remain common, the study indicates. The retrospective study of hospitalized children in the U.S. included the largest…
Necrotizing autoimmune myopathy (NAM) is a relatively recently discovered subgroup of inflammatory myopathies. NAM is characterized by predominant muscle fiber necrosis and regeneration with little or no inflammation.1 One subgroup of NAM is 3-hydroxy-3-methylglutaryl-CoA reductase antibody (HMGCR Ab)-related immune-mediated necrotizing myopathy (IMNM), which occurs (rarely) after statin exposure, with a rough incidence of two per…
Two decades have passed since the first biologic disease-modifying anti-rheumatic drug (bDMARD) was approved. Studies on the long-term use of biologics in different disease states, such as for cardiovascular disease (CVD) and malignancy, as well as for knee/hip replacement, reveal some encouraging news. In clinical trials, bDMARDs have been shown to increase the risk of…
What factors drive inflammation and progressive disease in ankylosing spondylitis (AS)? The answers have long eluded rheumatologists. Although 90% of patients with AS test positive for the HLA-B27 gene, pieces remain missing in our understanding of this chronic, inflammatory disease, which often leads to pain, spinal fusion and, in about half of patients, gut involvement,…
A recent prospective, observational cohort study of potential clinical biomarkers for progression to interstitial lung disease (ILD) in patients with early systemic sclerosis (SSc) found that higher levels of CCL2 circulating in their plasma predicted both faster ILD progression and poorer survival rates than in those with lower levels.1 CCL2, also known as monocyte chemoattractant…
When a young patient arrives at a clinic complaining of knee pain with clicking or popping, a meniscal tear is often the culprit. “In young [people], there’s a pretty classic presentation of meniscal tear, with clicking and other mechanical symptoms, because the tear rubs up against different tissues,” says Jeffrey Katz, MD, MSc, a rheumatologist…
They say the body remembers what the mind wants to forget. For those who have experienced trauma, not only does the body remember, in some cases it works on making things worse. Such is the situation with trauma and lupus, says a new study published in Arthritis & Rheumatology in October. The study, titled, “Association…
Is rheumatoid arthritis (RA) preventable? Results of a newly published study suggest that personalized medicine approaches may result in health behavior that may reduce RA risk. “We have gotten to the point where we’ve identified some modifiable behaviors that affect rheumatoid arthritis risk,” says Jeffrey A. Sparks, MD, MMSc, assistant professor of medicine in the…
A recent epidemiologic study of patients with systemic lupus erythematosus (SLE) investigated racial and ethnic differences in the risk for cardiovascular disease (CVD). Among SLE patients enrolled in Medicaid, the risk for myocardial infarction (MI) was lower in Hispanics and Asians compared with whites, and the risk of stroke was higher in blacks and Hispanics…
SAN DIEGO—The 2017 ACR/ARHP Annual Meeting kicked off on Nov. 4 with a rousing presentation by Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID). A terrorist attack on U.S. soil, hurricane, cyberattack and pandemic were the four scenarios played out in late 2016, when NIAID conducted a tabletop…
SAN DIEGO—After sifting through the nitty-gritty of the rheumatic disease literature on basic science, Richard Pope, MD—professor of medicine specializing in rheumatology at Northwestern University Feinberg School of Medicine—underscored several findings he thought stood out from the pack in his Year in Review talk at the 2017 ACR/ARHP Annual Meeting. He reviewed findings from November…
It’s one thing for a developing country to lack physicians due to a scarcity of training. It’s quite another for such a vacuum to exist because the physicians were executed. In Cambodia in the 1970s, genocide perpetrated by the Khmer Rouge spared few of the educated class. If they were spared, chances were they lost…
It happens every day. A new email pops up in a researcher’s in-box from a journal with a seemingly familiar name and an invitation to publish a research paper, present at a meeting or, perhaps, serve on an editorial board. Like many of her colleagues, Marian Hannan, DSc, MPH, professor of medicine at Harvard Medical…
The Presentation A pale, quiet woman—her mother—wheeled the girl into my clinic. It was a blistering Florida day, and the girl was shivering. She glanced up at me when I said hello and asked her name. “Hi,” she said, giving me a broad smile. Her smile was the only broad thing about her. Her elbows…
In 2010, Thomas Bartow, MD, FACP, finally ran out of excuses. Ever since high school, he had wanted to join the military. But too many things got in the way—like attending medical school at State University of New York at Stony Brook. After graduation in 1980, he performed his residency in internal medicine at Rush-Presbyterian-St….
Bisphosphonate Drug Holidays Drug holidays are common for patients on bisphosphonate therapy. Often, these breaks in treatment are related to known U.S. Food and Drug Administration (FDA) warnings and drug class adverse effects. Currently, data on fracture risk related to drug holidays are limited. In recent research highlighted at the 2017 ACR/ARHP Annual Meeting ,…
Mast cells may become a therapeutic target for low back pain, according to new research. Researchers found mast cells can infiltrate intervertebral disc cells and play a role in their degeneration. Specifically, mast cells and the cytokine, IL-6, were both more likely to be found in painful intervertebral discs surgically removed from patients than in control discs…
On Nov. 5, more than 100 students and residents gathered for the Rheumatology Research Foundation’s Student and Resident Experience at the ACR/ARHP Annual Meeting in San Diego. As part of the Foundation’s work to increase the number of rheumatology professionals in the U.S., the event is designed to increase excitement in the field. Attendees enjoyed…
The ACR Board of Directors approved the ARHP Master Designation at its August 2017 meeting. The first two ARHP Master Designation awardees will be honored at the ACR/ARHP Annual Meeting in Chicago on Oct. 20, 2018. Recognition as a Master of the ARHP is one of the highest honors that the ARHP bestows to members….
In a Year in Review session at the 2017 ACR/ARHP Annual Meeting, Daniel Solomon, MD, MPH, highlighted the latest and most intriguing aspects of clinical research on rheumatic diseases from 2017. His discussion touched on medical therapy, genetics, the effects of bariatric surgery and diet, cancer risk and more…
This is my fifth year serving on RheumPAC, and some of the questions that I repeatedly have been asked include: Why can’t I divide my investments into automatic monthly payments? Why can’t I invest from my phone? Why can’t I schedule an annual contribution so I don’t forget to invest? Why can’t I look up…
The healthcare industry is currently in an era of higher copays and deductibles, and effective patient collections are critical to the financial health of practices. The front desk staff of a practice is the first area to help with patient satisfaction and the key to a healthy revenue cycle. This front desk staff must collect…
1. A 68-year-old new female patient has an appointment to see the rheumatologist in four days. The patient has her medical records sent over from her primary care physician, neurologist and endocrinologist for the rheumatologist to review prior to the visit. Upon receipt, the rheumatologist spends 55 minutes reviewing the records and making notes. Can…
Take the challenge. 1. B—No. CPT 99358, prolonged evaluation and management service can be billed before or after direct patient care, first hour or 99539 —each additional 30 minutes (list separately in addition to code for prolonged service). This code cannot be used to bill a higher level E/M visit code. According to 2017 CPT:…