Biosimilars Receive Positive News On Nov. 19, 2015, the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) recommended granting marketing authorization for SB4, an etanercept biosimilar product that will be called Benepali.1 If approved, Benepali can be used to treat rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis and plaque psoriasis….
San Francisco, Nov. 6–11, 2015 The 2015 ACR/ARHP Annual Meeting in San Francisco was the most well attended in the College’s history. With the poster hall, exhibit hall, concurrent scheduling of multiple tracks and hundreds of scientific sessions presented during the event, the odds are good that even attendees missed a lot of what they…
SAN FRANCISCO—T follicular helper (Tfh) cells are emerging as an important subset of cells now recognized as important to facilitating an adaptive immune response. Developed during dendritic cell priming in vivo, these cells represent one subgroup among many of effector cells that result after naive CD4+T cells differentiate. Other well-known subgroups include Th1 cells, Th2…
SAN FRANCISCO—Evolving research into the pathogenesis of rheumatoid arthritis (RA) is increasingly showing that rather than a single causative dysfunctional pathway leading to disease, multiple pathways are involved, the study of which can shed additional light on what is occurring in a person’s body prior to developing symptoms of disease. Saying it another way, no…
Chronic pain can be one of the biggest challenges that patients and their physicians face. Rheumatology patients are no stranger to pain, and when pain goes beyond the scope of what rheumatologists can treat, collaboration with a pain specialist is common. “I refer patients to pain management when there is no underlying inflammatory condition, usual…
A patient returns for a follow-up visit of their chronic idiopathic gout without tophi with complaints of pain and tenderness. After a thorough examination, the rheumatologist treats the patient for an acute flare of the left knee. How is this coded? M1A.1620, M10.062 M1A.1620 M10.061 M10.062 From ICD-10 coding guidelines, what are the steps to…
Take the challenge. D—Even though the patient’s chief complaint is for a follow-up of chronic idiopathic gout without tophi, the patient is presenting with an acute flare of idiopathic gout of the left knee. Acute gout and chronic gout have specific coding guidelines, because they each have an Excludes 1 note. This indicates they are…
It was sixth grade, and Pierre Moeser—now a rheumatologist in St. Peters, Mo., who had already lived in his share of countries, saw a kid’s stamp collection displaying seemingly endless nations. Then and there, he got hooked on philately, “which is not just studying stamps, but also postal history and related items,” says Dr. Moeser….
Over the past several years, the ACR has ramped up its efforts in advocacy. Under the leadership of the Government Affairs Committee, many ACR staff, members and their patients, considerable progress has been made moving priority issues forward in 2015. A few highlights from 2015 include: The Patients’ Access to Treatment Act (PATA) was introduced…
One of your first clinical assignments as a medical student was likely to have been the lung exam. Its key descriptors may still resonate in your mind: inspection, palpation, percussion and auscultation. Proudly parading down the hospital corridors, your newly purchased stethoscope snugly tucked inside your lab coat pocket, you carefully place its cold metal…
The problem that dogs the work of all of those treating patients with antiphospholipid syndrome (APS) is the apparent lack of knowledge of the syndrome, both by the general public, as well as by swaths of the medical fraternity. Perhaps it was ever thus—a syndrome less than 40 years old could be described as new,…
The Case A 41-year-old woman was referred to the dermatology clinic for a three-month history of tender lesions on her elbows and around the joints of her hands. Her medical history was notable for seropositive, non-erosive rheumatoid arthritis (RA), which was being treated with 5 mg prednisone daily, 10 mg methotrexate weekly by mouth, 200…
SAN FRANCISCO—By harnessing the power of next generation sequencing strategies and combining them with clever statistical strategies and tools, investigators are striving to define causal pathways of and mechanisms underlying complex diseases, such as rheumatoid arthritis, according to Soumya Raychaudhuri, MD, PhD, associate professor, Harvard Medical School, Brigham and Women’s Hospital, Boston, during a session…
It is valuable to understand the semantics of consultant comments. A journal article I once read indicated that when a consultant reports having seen a series of individuals with a given problem, it means they have seen two cases. When they report they have experience with a problem, they mean they have seen a (one)…
Approximately 10 years ago, the Office of Inspector General (OIG) issued its first guidance on compliance as it relates to federal mandates for physician practices. Although taking the necessary steps can be a daunting task in an era of complex rules and heightened regulations, there are key areas of government-mandated compliance requirements that practices should…
On Nov. 2, 2015, Congress passed the Bipartisan Budget Act of 2015. The Act contained a nasty surprise change to Social Security claiming strategies. Two commonly recommended strategies are known as file and suspend and restricted application. Both of these strategies will be going away, but not immediately. A lucky few will be grandfathered in….
A 47-year-old Caucasian woman presented to the rheumatology clinic with a one-year history of pain and swelling involving the wrists, hands, ankles and feet that progressively worsened. Her symptoms included generalized fatigue, morning stiffness in the hands and lower back lasting more than an hour, Raynaud’s phenomena (triphasic), photosensitivity, tightening of the skin of the…
When rheumatoid arthritis (RA) left Stefanie Gluckman fighting chronic pain and relegated to a wheelchair, she turned to Lori Rubenstein Fazzio, DPT, PT, MAppSc, YTRX, of Mosaic Physical Therapy in Los Angeles, for relief. Dr. Rubenstein Fazzio knows what it’s like to suffer from excruciating pain. After sustaining career-threatening injuries in a horseback accident in…
To blog or not to blog? As a rheumatologist, you may have pondered this question. Perhaps getting some insight from rheumatologists who already blog and a professional blog writer may help you find the answer. Obviously, if you devoted time to blogging you would want it to be beneficial. For Paul Sufka, MD, rheumatologist, HealthPartners,…
SAN FRANCISCO—Research is revealing more clues about the environmental factors that likely play a role in triggering rheumatoid arthritis (RA) in patients who are susceptible—or that may even protect them from autoimmunity. Large-scale, lengthy population studies conducted at institutions worldwide provide in-depth data from which to identify potential triggers and protective factors for RA, from…
SAN FRANCISCO—The risk of stroke after herpes zoster (HZ) infection is elevated in the period immediately after infection in patients with autoimmune diseases, according to a study presented at the 2015 ACR/ARHP Annual Meeting.1 The findings were presented in a scientific session, called Discover 2015, that highlighted new research. In another study from the session,…
SAN FRANCISCO—Men and women have different mechanisms that are at work in producing pain in rheumatic diseases—a little-studied and little-appreciated fact that is crucial to developing and using the right kinds of treatments, an expert in rheumatic disease pain said in a talk at the 2015 ACR/ARHP Annual Meeting. The lack of acknowledgment of this…
SAN FRANCISCO—Treatment for transthyretin-related amyloidosis (ATTR) is generating more interest from academic researchers and the pharmaceutical industry, with encouraging early results using a multi-pronged therapeutic approach, a researcher said at a review course held before the 2015 ACR/ARHP Annual Meeting. Amyloidoses are a rare and potentially deadly family of diseases in which misfolded protein builds…
SAN FRANCISCO—Behçet’s disease is a vasculitis that can be hard to pin down, with a wide variety of manifestations, many of which overlap with other auto-inflammatory conditions, an expert said at a clinical review course at the 2015 ACR/ARHP Annual Meeting. The most common feature is oral ulcers, which are expected to be seen at…
SAN FRANCISCO—Metabolomics could one day be a treasure map of information about inflammation in rheumatic disease. There are many metabolic pathways to pursue for clues on how to reverse this damaging process. “All of these signaling pathways are interrelated and affect each other,” said Douglas J. Veale, MD, director of translational research at Dublin Academic…
SAN FRANCISCO—To help rheumatologists better understand the underlying mechanisms of autoimmune diseases, Mark Anderson, MD, PhD, professor of adult endocrinology, University of California, San Francisco, spoke during the 2015 ACR/ARHP Annual Meeting on ways in which immune regulation and tolerance work to ensure health in individuals who maintain tolerance to self-antigens and how these processes…
SAN FRANCISCO—To date, evidence on the efficacy of blocking the cytokine tumor necrosis factor (TNF) and its receptors in autoimmune diseases has resulted in the approval by the Food and Drug Administration (FDA) of five anti-TNF agents. Less well known, according to Richard Siegel, MD, PhD, chief, Immunoregulation Section, Autoimmunity Branch, and Clinical Director, NIAMS,…
Patient portals are online programs and applications that help patients and physicians interact. Although there are many different implementations, most will have some sort of messaging component to help with communication between the doctor and the patient, as well as access to at least some elements of the chart, such as test results. “Patients should…
On Nov. 2, 2015, President Barack Obama signed the Bipartisan Budget Act of 2015 (the Act) into law. This critical piece of legislation raises the federal debt ceiling and provides the framework for the federal budget through 2017. Of particular importance, the Act significantly changes the way Medicare will reimburse hospitals for outpatient services furnished…