A typical patient with a rheumatic disease needs a multifaceted treatment approach to address comorbidities, minimize disability, promote quality of life and improve survival. To achieve these outcomes, rheumatology research has evolved from examining a single treatment to studying the best treatment approaches. Examples of these strategy trials include how to best combine pharmaceutical therapies,…
2018 is coming to a close, and somehow, I have managed to make it through a year as the physician editor of The Rheumatologist without being sued or fired, so I thought this would be a good time to pause and reflect on lessons learned—and to give thanks. My first lesson: this is a lot of…
The ACR and the Rheumatology Research Foundation have a rich history of collaboration and significant achievement. In many ways, our collaboration has become the classic triple threat of medicine, as we endeavor to support research, advance clinical care and expand education in so many intertwined and inseparable ways. Although we are greatly encouraged by the…
As rheumatologists, we have a love-hate relationship with the corticosteroid prednisone, a feeling many of our patients share. It’s our most effective medication to quickly shut down an overactive immune system. When we have a patient with life- or organ-threatening autoimmune disease—severe lupus affecting the kidneys or vasculitis causing hemorrhage in the lungs, for example—large…
In September, the ACR participated in a global rheumatology event by partnering with the Emirates Society of Rheumatology (ESR) to jointly produce an educational meeting. The 4th Annual Conference of the Emirates Society of Rheumatology, in partnership with the ACR, took place Sept. 19–21 in Dubai Festival City, Dubai, United Arab Emirates (UAE). The conference…
Patients under the care of the U.S. Veterans Affairs who were older, non-white and had more comorbidities were less frequently given biologic initiation therapy to treat their rheumatoid arthritis (RA), according to a recent study. Researchers sought to identify predictors of greater use of biologic therapies, as well as factors associated with persistent use of…
Rheumatologists prescribe rituximab for induction and maintenance treatment for anti-neutrophil cytoplasm antibody (ANCA) associated vasculitides (AAV). Maintenance treatment typically employs fixed-schedule dosing, but in the recent maintenance of remission using rituximab in systemic ANCA-associated vasculitis II (MAINRITSAN2) trial, researchers from the French Vasculitis Study Group examined whether individually tailored maintenance dosing might work better. “The…
Researchers sought to identify predictors of patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) who took rituximab for maintenance had a better sustained remission rate through 60 months than those taking azathioprine, according to the latest results from the maintenance of remission using rituximab in systemic ANCA-associated vasculitis (MAINRITSAN) trial, a prospective, randomized trial…
Primary Sjögren’s syndrome is a systemic autoimmune condition noted for findings of xerostomia, keratoconjunctivitis sicca and focal lymphocyte infiltrate in salivary glands.1 In the initial publications regarding keratoconjunctivitis sicca, Henrik Sjögren, a Swedish ophthalmologist, described a group of 19 women with dry eyes, some of whom had other organ dryness and inflammatory infiltrates.2,3 The syndrome…
A 39-year-old woman presented at the emergency department with three weeks of progressive, constant and pulsatile right-sided headache. She said her headache was worse in the morning and when she would bend forward. She reported associated nausea and vomiting. On initial assessment, she did not have any focal neurological deficits. Her medical history was significant for…
More than 10 years ago, I wrote a commentary in The Rheumatologist, called “Perils of Pain Meds,” about the over-prescribing of opioid analgesics for common causes of chronic noncancer pain, which was a major contributor to the opioid epidemic.1 Since that time, although there has been a greater than 20% decrease in opioid prescribing, the…
Varicella-zoster-virus (VZV) reactivation, which can cause patients to develop herpes zoster (i.e., shingles), occurs more frequently in patients with systemic vasculitis and systemic lupus erythematosus (SLE) who have received intravenous cyclophosphamide than in otherwise healthy adults, according to a retrospective study published in The Journal of Rheumatology by researchers in France.1 The study also shows…
Genes may predispose people to have certain microbial signatures in their gut that, in turn, make them susceptible to developing reactive arthritis. This is the main finding of a recent study in which researchers investigated whether perturbations in the intestinal microbiome play a role in susceptibility to reactive arthritis in the face of triggers, such…
“You’re probably going to die tonight. You should call your family.” Jonathan Koch, president and CCO of Asylum Entertainment LLC, told his touching and inspiring story of mysterious illness, resilience and recovery in the keynote presentation of the 2018 ACR/ARHP Annual Meeting.
CHICAGO—Findings on opioid efficacy, serum urate in osteoarthritis and arthrocentesis headlined the top research of the year discussed in the first half of a session at the 2018 ACR/ARHP Annual Meeting. The second half covered basic science findings, including summaries of new insights into the gender bias in autoimmune diseases, platelet microparticles in scleroderma and…
CHICAGO—ACR leaders described a series of looming legislative and regulatory threats to rheumatologists and their patients—including the proposed collapsing of evaluation and management (E/M) coding and potential changes to step therapy rules—and urged everyone in the field to make their voices heard to quash the proposals. They also recounted recent victories in the policy realm…
CHICAGO—Approximately 200,000 health apps are available through major app stores. Some offer real benefits, said Brennan Spiegel, MD, MSHS, director of health services research at Cedars-Sinai Health System, Los Angeles, Calif. But most, he told attendees at the 2018 ACR/ARHP Annual Meeting, are “rubbish.” “They do one or two things only—and generally not well,” he…
CHICAGO—Rheumatology physicians and researchers from Africa said the field’s resources and medical literature on the continent are slowly expanding, but they repeatedly lamented that the millions who suffer from rheumatic diseases there have major obstacles to overcome to access care. Their reviews and assessments—sometimes grim and sometimes hopeful—came in a session that was a joint…
CHICAGO—Throughout medical training, you have guideposts and guardrails all around you: academic advisors, professors in the classroom, preceptors in the clinic during residency. But once you get a job as a medical faculty member, you’re basically on your own. “No one really trains you or teaches you about how you’re supposed to negotiate and navigate…
CHICAGO—Teaching in the inpatient setting can be a tall task, hindered by a lack of time, an unpredictable environment and a variety of learners encountered at different levels. But a few techniques—based mainly on understanding who your students are and how they prefer to learn—can make a big difference, an expert said at the 2018…
CHICAGO—At the 2018 ACR/ARHP Annual Meeting in October, 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 winners of the ARHP Merit Awards about their individual contributions to advancing rheumatology. You’ll also find interviews…
It was never in the plan for Jessica Farrell, PharmD, to enter rheumatology. In fact, when she applied for one of two pharmacist positions at Albany College of Pharmacy and Health Sciences in 2008, she made it clear she was only interested in the family practice position. “I was offered an interview for the family…
An analysis of treat-to-target therapy assessing two ultrasound definitions of remission for patients with early rheumatoid arthritis (RA) has concluded that using ultrasound remission as a target was not associated with better long-term outcomes for RA patients.1 Compared with MRI, ultrasound costs less, is more accessible and offers the ability to scan more joints in…
The Division of Rheumatology and Immunology at the Medical University of South Carolina (MUSC), Charleston, was formally established in 1974 by its first division chief, E. Carwile LeRoy, MD. Twenty-one years later, when Richard M. Silver, MD, assumed leadership, the division had acquired international renown for its scleroderma research. Now, having just retired as division…
We have all been to numerous lectures, grand rounds and other continuing medical education activities where the speaker, prepared and poised at the podium, begins his lecture with a title slide. Soon after, we see the ubiquitous conflicts of interest slide, which lists the invited speaker’s research funding, his consulting activities and his board memberships—all…
Two years ago, Carla Guggenheim, DO, a rheumatologist in private practice in Lansing, Mich., was recovering from extensive shoulder surgery when her dance teacher asked her to perform a complex Indian piece from the Bharatanatyam Repertory at a gala showcasing graduate dance students. Because of her surgery, Dr. Guggenheim agreed to dance only 90 seconds…
Rheumatology is truly a people specialty: We often develop lifelong relationships with our patients as well as our colleagues. We increasingly recognize that providing the best rheumatologic care requires a team effort. The collegial nature of our specialty is reflected in the ACR’s mission statement: To empower rheumatology professionals to excel in their specialty. In…
The Rheumatology Research Foundation’s Honorary Board of Advisors is reserved exclusively for individuals who have made a transformative contribution, via a significant donation or through leadership, leaving an indelible mark on the organization’s future fundraising success. This year, Audrey M. Nelson, MD, from the Mayo Clinic, and ACR Executive Vice President Mark Andrejeski were named…
In 2018, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicaid & Medicare Services (CMS) reducing reimbursement through its proposal to combine evaluation and management codes in the Physician Fee Schedule? If your answer to any of those questions is yes, then you…
In an already complicated reimbursement landscape, claims denials can potentially pose a serious issue to the financial revenue for rheumatology practices. Denials are not only highly prevalent in the healthcare environment, but also costly to appeal, which affects overall reimbursements. According to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting…
Find the words/terms suggested by the following clues: What is the procedure conducted when a permanent picture is required for a joint injection? What is another name for a joint injection? What should be done when a patient returns for an infusion and a prior authorization has already been approved? On what body system is…
Take the challenge. Ultrasound guidance: There must be a permanent picture placed in the patient’s medical chart to meet the requirements of documentation guidelines. Arthrocentesis: This is the proper term for the withdrawal of fluid and/or injection of medication into a joint. If both the aspiration and injection are performed during the same encounter, only…
During a five-year trial of canakinumab, patients with systemic juvenile idiopathic arthritis taking canakinumab showed progress toward clinical remission and glucocorticoid tapering…
An exploratory analysis of a canakinumab clinical trial has shown the interleukin 1β inhibitor may significantly reduce patients’ risk for gout flares. During the study, patients using canakinumab experienced this decreased risk, but the treatment did not change serum uric acid levels…
Recent research demonstrated that fibromyalgia patients have lower cerebral blood flow velocity variability than healthy controls, which may reflect impaired coordination of cerebral regulatory systems. This analysis may be a promising tool for characterizing fibromyalgia pathology and understanding health-related quality of life…
Early in her medical school career, Beth Jonas, MD, FACR, was fascinated by the multi-system and chronic nature of rheumatic diseases. The field of rheumatology offered her the chance to make long-term connections with the patients she cares for, and she says her early instincts have led her to a career that has not disappointed….
A patient Zachary Wallace, MD, MSc, met during his third year of medical school at Georgetown University helped lead him to his passion for rheumatology. He was completing a clinical rotation in medicine, and the experience made rheumatologic disease tangible for him. “She had lupus, and I became interested in her case,” he says. Later,…
NEW YORK (Reuters Health)—Ixekizumab improves signs and symptoms in patients with radiographic axial spondyloarthritis (ankylosing spondylitis), according to results from the COAST-W study. “Ankylosing spondylitis is a chronic and debilitating disease, and I have a large number of patients who have failed TNF inhibitors,” says Dr. Atul Deodhar from Oregon Health and Science University, Portland….
Sen. Susan Collins (R-Maine) is the recipient of the ACR’s 2018 Award for Public Leadership in Rheumatology. Sen. Collins has championed several pieces of legislation that support rheumatologists and rheumatology patients, and she has taken part in multiple efforts to address ongoing concerns in rheumatology. “Sen. Collins has consistently worked both sides of the aisle…
The FDA has approved an update for rituximab’s label, which will include safety and efficacy information for treating ANCA-associated vasculitis…
In a four-year study, patients with active psoriatic arthritis (PsA) experienced sustained improvement in PsA signs and symptoms on secukinumab…
The FDA has approved the use of sublingual sufentanil (Dsuvia) to treat acute pain in adults in a medically supervised setting…