Systemic lupus erythematosus (SLE) is an autoimmune-mediated rheumatic disease characterized by multisystem involvement that can cause significant morbidity and mortality. Acute disseminated encephalomyelitis (ADEM) is a rare, fulminant, autoimmune-mediated, demyelinating disease involving the white matter of the central nervous system (CNS), and is considered a manifestation of neuropsychiatric lupus. Few reported cases involve SLE and…
Every year, my program goes through a ritual—I scrub my face, put on a smile and meet hordes of medical residents from across the country. And every year, I do my best to convince all of them that Baltimore would be an amazing place for them to complete their medical subspecialty training in rheumatology. Now…
Education is a vital component of what the ACR provides to rheumatology professionals around the world, and the ACR’s commitment to continually expand options to access the latest science and medical education is critical to all involved in the specialty. This dedication is reflected in the ACR’s new mission, vision and brand promise, all of…
Although two decades have ticked by, rheumatologist Michael Lockshin, MD, MACR, still remembers the enlightening nature of many conversations he had with his curious and persistent patient Barbara Volcker, the wife of former U.S. Federal Reserve Chairman Paul Volcker. “The conversations we had at that time led to the mission of the Barbara Volcker Center,”…
SAN DIEGO—The 2017 ACR/ARHP Annual Meeting, Nov. 3–8, presented opportunities to highlight its 2017 legislative advocacy victories, some of which were resolved just weeks before the conference began, as well as issues that are still outstanding. In the session, Legislative & Regulatory Update 2017, Angus Worthing, MD, chair of the ACR’s Government Advocacy Committee and…
SAN DIEGO—Doctors vote less frequently than other professionals, even than farmers, reported Sen. Tim Hutchinson, who is the ACR’s lead lobbyist inside the Beltway, during an Introduction to Advocacy workshop at the 2017 ACR/ARHP Annual Meeting Nov. 3–8.1 Sen. Hutchinson, who represented Arkansas in the U.S. Senate from 1997–2003 and is now a senior director…
SAN DIEGO—It’s no secret: Autoimmune, inflammatory rheumatic disease raises a patient’s risk of cardiovascular disease (CVD). “Inflammation may affect all aspects of the cardiac structure and function,” said Rekha Mankad, MD, FACC, director of the Women’s Heart Clinic at the Mayo Clinic in Rochester, Minn. Dr. Mankad also oversees a cardio-rheumatology clinic to assess and treat…
SAN DIEGO—In many regions, rheumatologists are scarce, and shortfalls will only increase. Panelists in the session, Telehealth: Can It Expand the Rheumatology Workforce?, held Nov. 6 during the 2017 ACR/ARHP Annual Meeting, believe technology can help bridge the gap. The more specific term, telemedicine, “refers to clinical care delivered from a distance,” said John A….
SAN DIEGO—Proposed classification criteria for systemic lupus erythematosus (SLE), which are supported but not yet approved by the ACR and EULAR, debuted on Nov. 7 at the 2017 ACR/ARHP Annual Meeting. An international steering committee developed and validated the criteria, with patient input and the consensus of more than 150 global SLE experts. Researchers referred…
SAN DIEGO—B cell signaling goes awry in many patients with systemic lupus erythematosus (SLE), triggering pathogenic autoimmune responses and clinical disease. At the Rheumatology Research Foundation’s 2017 Evelyn V. Hess Memorial Lecture, held on Nov. 5 at the ACR/ARHP Annual Meeting, researcher Ignacio Sanz, MD, discussed B cells’ role in this complex disease. Because lupus…
SAN DIEGO—Should patients with rheumatic diseases switch from a biologic to its biosimilar? At the 2017 ACR/ARHP Annual Meeting’s Great Debate, held Nov. 5, two rheumatologists argued whether to switch or stay put based on safety, efficacy and potential cost savings. First to the podium to make the case for switching, Jonathan Kay, MD, tweaked…
SAN DIEGO—Rheumatologists who treat lupus patients gleaned tips on diagnosis and management of renal disease, painful neuropathies and alopecia at a “Curbside Consults” session held Nov. 6 at the ACR/ARHP Annual Meeting in San Diego. Membranous Lupus Nephritis Patients with refractory membranous lupus nephritis (MLN), or Class V lupus nephritis, face “significant morbidity, most of…
SAN DIEGO—Exercise, within limits imposed by an individual’s circumstances, is an almost universally beneficial medical therapy. In fact, Teresa J. Brady, PhD, senior behavioral scientist with the federal Centers for Disease Control and Prevention’s Arthritis Program, labeled it “medicine” in a session on exercise at the 2017 ACR/ARHP Annual Meeting Nov. 3–8. Dr. Brady asked whether…
SAN DIEGO—Pharmacy benefit managers (PBMs) and their impact on drug prices and access to high-cost medications by the patients rheumatologists treat was a major theme at the 2017 ACR/ARHP Annual Meeting Nov. 3–8. In one session, industry experts tried to clarify the role for prior authorizations and drug formulary policies and explored ways to constructively…
SAN DIEGO—Fibrosis affects all organ systems, but isn’t always systemic sclerosis. Experts on less common forms discussed patient presentations, diagnosis and treatment at the 2017 ACR/ARHP Annual Meeting in San Diego on Nov. 6. Retroperitoneal Fibrosis Formerly called Ormond’s disease, retroperitoneal fibrosis (RPF) is usually an IgG4-related disease, but has some unique characteristics, said John…
For Daniel Albert, MD, a rheumatologist with the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., some of his most defining medical experiences haven’t taken place within his practice, but in exotic locales such as a rainforest on the island of Borneo. One of many physicians across the world who volunteer their time and expertise on medical…
When a patient has fibromyalgia, sleep troubles are the last thing they need. Unfortunately, sleep problems affect a large number of fibromyalgia patients, and those problems can turn into a vicious cycle that interplays with daytime pain and fatigue. “Pain and sleep disturbances are a double-edged sword,” says Elika Kormeili, MFT, a licensed clinical psychologist…
A person living with lupus may feel isolated. They receive information from their doctor, but it’s never enough to fully understand the disease. So where do they turn? Social media, where they can connect, share information and learn. A new social media initiative, Hablemos de Lupus—which translates to Let’s Talk About Lupus—focuses on sharing…
If you read The Rheumatologist regularly, you may remember a column I wrote a few months ago about giving and receiving feedback (July 2017). I wrote it when I was finishing fellowship and looking back at six years of my graduate medical education. Now, as an attending physician who spends a considerable amount of time…
SAN DIEGO—At the 2017 ACR/ARHP Annual Meeting in San Diego in November, 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 ARHP winners about their individual contributions. In addition, we profile the new class…
The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…
The Case A 58-year-old patient with knee osteoarthritis has been decreasing her physical activity over the past several years due to painful joints, which has resulted in significant weight gain. At her appointment, you encourage her to engage in more physical activity and eat a well-balanced diet. A few weeks later, the patient returns to…
New RA Antibody Treatment SAN DIEGO—A recent study examined the pharmacokinetics, safety and efficacy of E6011, an anti-fractalkine monoclonal antibody designed to treat rheumatoid arthritis (RA).1 Researchers presented the results of this first 52-week trial of E6011 at the 2017 ACR/ARHP Annual Meeting in November. Fractalkine (CX3CL1/FKN) is a chemokine that regulates chemotaxis and adhesion…
SAN DIEGO—In November, the Rheumatology Research Foundation honored 155 award and scholarship recipients at the Awards Celebration, an annual luncheon, held in conjunction with the ACR/ARHP Annual Meeting. The event celebrates the accomplishments of rheumatology professionals who have received funding from the Foundation. In congratulating the award recipients, executive director Mary Wheatley, CAE, IOM, emphasized…
In 2017, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicare & Medicaid Services (CMS) reducing reimbursement through its proposed Part B Demonstration Project? If your answer to any of those questions is yes, then you directly benefited from the ACR/ARHP’s advocacy efforts….
The operations management team in healthcare practices is expected to have an effective coding compliance program in place that is continually evaluated and reevaluated. To accurately assess the program’s effectiveness, several outcome indicators must be measured, including error rates in the provider’s documentation and the electronic health record (EHR). Due to increased scrutiny by the…
An established, 66-year-old male patient with rheumatoid arthritis who was last seen in the office three weeks before returns to the office for an infliximab infusion. The patient reports mild pain in his right knee, right and left elbows. He rates the pain severity at a 3 on a 10-point scale. He denies any weight…
Take the challenge. No, this claim is lacking proper documentation to be billed out correctly and requires querying the provider before submitting to the payer. First, a query is a written or verbal question concerning the documentation of what is being billed out and should be visible in the patient’s chart. If a query is…