Erdheim-Chester disease (ECD) is a rare, non-Langerhan’s cell histiocytosis characterized by tissue infiltration of CD68-positive and CD1a-negative foamy histiocytes.1 ECD was discovered as a lipid granulomatosis in 1930 by Jakob Erdheim and his pupil, William Chester, and approximately 500 cases have been described to date.1 ECD has a heterogeneous course and prognosis ranging from an…
Soon, rheumatologists may have another drug to offer their patients with refractory rheumatoid arthritis (RRA) for whom effective and safe treatment remains challenging. A study published in the New England Journal of Medicine shows that patients with RRA treated with once-daily baricitinib in a 4 mg dose had a significant clinical improvement in symptoms of…
Bone health in general, and osteoporosis in particular, is among the most common conditions seen in rheumatology practices. The ACR recently joined the National Bone Health Alliance (NBHA) to reach out to other stakeholders. “In 2004, the Surgeon General of the United States published a report on osteoporosis that discussed in depth the gaps in…
WASHINGTON, D.C.—As treatments for rheumatoid arthritis (RA) improve, some related conditions that used to be common in patients with RA are not seen very often anymore, but they still exist and physicians need to know how to identify them. Speaking to attendees at the ACR/ARHP Annual Meeting talk titled Rheumatoid Arthritis—A Case-Based Approach to Selected…
Corticosteroids still represent the mainstay of treatment of patients with active disease. They have been used for more than 60 years, and although prolonged use is associated with organ damage, they have been shown to be lifesaving in various phases of the history of the disease. History of Use First introduced in the late 1960s…
A new presidential administration took office in January 2017. Although no one truly knows what directions our government and economy will take, one projection is that healthcare regulatory and insurance coverage policies will change, possibly dramatically. In a time of uncertainty, rheumatologists and rheumatology health professionals can turn to the ACR/ARHP for support, guidance and…
Over the past two decades, many physicians have ironically abrogated their intellectual abilities by resigning themselves to a fate of being worthless unless they work for someone else. Many factors have contributed to this process, including, but not limited to, declining reimbursements, escalating costs, onerous electronic record mandates, intense competition from hospital conglomerates and burdensome…
In 1982, my wife (also a rheumatologist) and I attended our first American Rheumatism Association (now the ACR) national meeting. After the meeting we stayed with a friend in a suburb of Boston, where we also had the opportunity to meet our hostess’ in-laws, a retired general practitioner and his wife. When her father-in-law shook…
“It is not necessary to change. Survival is not mandatory.” —W. Edwards Deming For practices to survive, change is a requirement—not an option—in the rapidly evolving practice of rheumatology care. Pharmaceutical therapies are advancing quickly, opening the door for game-changing therapies in the treatment of chronic autoimmune disorders. With these advances comes a need for…
SAN FRANCISCO—Interstitial lung disease (ILD) represents a heterogeneous group of disorders characterized by inflammation or fibrosis of the lungs. The disorders are also associated with a spectrum of connective tissue diseases (CTDs). ILD is a common manifestation of CTDs, such as scleroderma, poly-/dermatomyositis and rheumatoid arthritis—and is a leading cause of morbidity and mortality in…
WASHINGTON, D.C.—Paulette Hahn, MD, associate professor of medicine specializing in rheumatology at the University of Florida (UF), said she once treated a patient named Monica, a UF undergraduate who had severe inflammatory muscle disease and severe lung disease. The patient’s disease was under control for the time being, but Monica knew she could take a…
WASHINGTON, D.C.—“Rheumatic manifestations are [often] the initial presentation of a systemic disease, but they can [also] occur during the course of the disorder,” said Joseph Markenson, MD, speaking in the ACR/ARHP Annual Meeting talk, Rheumatic Manifestations of Endocrine Disease, during the ACR Review Course. Dr. Markenson is professor of clinical medicine and a rheumatologist at Weill…
WASHINGTON, D.C.—Despite the value of guidelines, they often “are not read,” said N. Lawrence Edwards, MD, professor of medicine specializing in rheumatology at the University of Florida, at the 2016 ACR/ARHP Annual Meeting talk titled, New & Emerging Therapies for Gout, as part of the ACR Review Course. Or if they are read, they aren’t…
WASHINGTON, D.C.—The vast majority of the attention given to vasculitis at the ACR/ARHP Annual Meeting, year after year, focuses on ANCA-associated vasculitis and large-vessel vasculitis, said Philip Seo, MD, MHS, director of the Johns Hopkins Vasculitis Center and moderator of the 2016 ACR Review Course titled, Neglected Vasculitis. That leaves out a lot. “These are…
WASHINGTON, D.C.—New insights into maintenance therapy for patients with vasculitides were covered by several speakers at the 2016 ACR/ARHP Annual Meeting abstract session titled, Vasculitis I: Novel Approaches to Therapy. Expert Hubert de Boysson, MD, MSc, of the Internal Medicine Department at Caen University Hospital in France, led discussion on new therapies for patients with…
WASHINGTON, D.C.—Often, no clear explanation exists in neutrophilic dermatosis cases that links a patient’s skin disorder with an internal condition, expert Joseph Jorizzo, MD, professor, founder and former chair of the Dermatology Department at Wake Forest University in Winston-Salem, N.C., and professor of clinical dermatology at Wevascularill Cornell Medical College in New York, told attendees…
WASHINGTON, D.C.—Addressing a gathering of healthcare providers at the 2016 ACR/ARHP Annual Meeting concurrent session titled, Pediatric Rheumatology for the Adult Rheumatologist, part of the ACR Review Course, expert Sangeeta Sule, MD, PhD, associate professor of pediatrics specializing in rheumatology at Johns Hopkins Hospital in Baltimore, displayed a color-coded map of the U.S. on which…
WASHINGTON, D.C.—Rheumatology researchers look for next-generation treatments, healthy interventions, and genetic and microbial clues to disease pathogenesis and therapy response, according to new studies presented at a Nov. 15, 2016, press conference at the 2016 ACR/ARHP Annual Meeting. OA & Physical Function How do you know when a patient with knee osteoarthritis (OA) has the…
WASHINGTON, D.C.—In the next 15 years, it will be increasingly difficult to provide adequate care for rising numbers of patients with rheumatic diseases due to a severe shortage of trained rheumatology healthcare providers, according to the ACR’s 2015 Workforce Study of Rheumatology Specialists in the United States. The full study is available online, and panelists…
WASHINGTON, D.C.—Patients with juvenile rheumatic diseases are thriving in an era of highly effective therapies, successful self-management strategies, better understanding of genetic links to autoimmunity risk and improved efforts to listen to and engage with these young patients. That bright picture for young people with arthritis was presented by pediatrics at the ACR/ARHP Concurrent Abstract…
WASHINGTON, D.C.—In 2017, rheumatologists will begin to track and report quality data for reimbursement under the the Medicare and CHIP Reauthorization Act of 2015 (MACRA). Panelists shared their tips on how to score more points under MACRA and utilize existing technology at a Nov. 14 session called Implementing Quality Measurement in Your Clinical Practice at…
WASHINGTON, D.C.—What do treating hand osteoarthritis (OA) in the primary care setting, high financial strain and risk of depression in patients with lupus, prolonged sitting and cardiovascular disease, and sex-specific treatment after total hip arthroplasty have in common? They were all topics presented during a session titled ARHP I: Exemplary Abstracts at the 2016 ACR/ARHP…
WASHINGTON, D.C.—Calling it an extremely challenging topic, Peter K. Gregersen, MD, professor and head, Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute, Manhasset, N.Y., said the current role of genetics in clinical practice is less about how to use genetic information to care for patients and more about how providers and patients…
Each fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) puts out its Work Plan for the upcoming fiscal year to summarize its initiatives and priorities for new and ongoing work of HSS programs. Below is a summary of the key areas the OIG will focus on in 2017: Drug…
As part of the Rheumatology Research Foundation’s Visibility Initiative, the Rheum Life campaign was developed as a way to share a patient’s perspective of what life is like with a rheumatic disease. Rheum Life also provides insight into current Foundation-funded research and the impact it will have on the lives of these patients. Exposure to…
In 2016, the ACR and the Arthritis Foundation teamed up to direct $20 million within the Department of Defense’s (DoD’s) Congressionally Directed Medical Research Program (CDMRP) to arthritis treatment and prevention. The CDMRP has millions of research dollars that have not been committed to specific items. In the new appropriations cycle, we are once again…
Guselkumab Improves Active Psoriatic Arthritis New research has revealed that patients with active psoriatic arthritis (PsA) and ≥3% body area of plaque psoriasis benefit from treatment with a human monoclonal antibody known as guselkumab (GUS). GUS is specific for the p19 subunit of interleukin 23 (IL-23). Patients in the Phase 2 clinical trial experienced significant…
Eight years ago, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs embarked on a comprehensive review of the AMA Code of Medical Ethics. What emerged after years of hard effort, intensive feedback and thoughtful revisions was a modernized version of the guide, which the AMA House of Delegates voted to adopt in…
Rheumatologists are accustomed to educating patients about medications—but biologic medications require some additional time and discussion. “Biologics are inherently more complex [than other medications], and there are multiple issues to consider before initiating treatment,” says K. “Kwas” Huston, MD, The Center for Rheumatic Disease, Kansas City, Mo. “This includes the patient’s disease activity, prior medications…
“To err is human.” —Alexander Pope (1688–1744) The Wisest Minds in Medicine At some point during our careers, we have the privilege of meeting a physician so talented that everyone else pales in comparison. These are those gifted clinicians whose astonishing mastery of medicine makes everyone in their midst feel like inept, babbling fools. They…