CHICAGO—A 49-year-old woman has had RA for eight years. She has a rheumatoid factor reading of 35, an aCCP reading of 160, erythrocyte sedimentation rate of 42, plus erosions. She has been on methotrexate. She tried etanercept for six months, but then it stopped working. She was on 40 mg of adalimumab weekly, but it…
There can be a rhythm to rheumatology. At least that’s what Alain Alvarez, MD, can sometimes find. Listening, assessing, helping. It can be a successful dance when doctor and patient become partners, hoping to lead each other forward. When you consider this, it might be little surprise that Dr. Alvarez is also a dance teacher….
Arthritis Center Renamed to Honor Ephraim P. Engleman, MD Ephraim P. Engleman, MD, has been on the faculty at the University of California, San Francisco (UCSF) since 1947, 10 years after he received his MD from Columbia University. The 104-year-old rheumatologist is currently the director of the Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, which…
PSOLAR, the Psoriasis Longitudinal Assessment and Registry, is a multicenter, longitudinal, intercontinental, disease-based registry used to identify adverse events from commonly used psoriasis drugs.1 An evaluation of the risk of serious infection from systemic psoriasis treatments was recently published using data from PSOLAR. Ninety-three institutional review boards or ethics committees reported into the registry from…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History A 56-year-old man with end-stage renal disease on peritoneal dialysis presents…
View the question. Findings/Diagnosis The AP radiograph of the left shoulder (see Figure 1) shows erosions of the proximal humeral and glenoid articular surfaces (black arrows) without joint-space narrowing. There is a well-defined marginal erosion with overhanging edge at the junction of the proximal humeral articular surface and rotator cuff insertion on the greater tuberosity (ellipse)….
CHICAGO—David Daikh, MD, PhD, professor of medicine at the University of California San Francisco and chief of the Rheumatology Division at the San Francisco VA Medical Center, said the overlap between malignant disease and rheumatic disease means rheumatologists should stay aware that more may be going on than just a rheumatic disorder. He made his…
In terms of getting our message heard in Washington, D.C., rheumatology faces a David vs. Goliath battle on several levels. Many industries have far greater resources, use multiple lobbying firms, and have advertising and lobbying budgets that eclipse ours by several hundred-fold. Rheumatology is far smaller than most other medical specialties; our membership is a…
Coding for SI Injections with Office Visit A female patient previously diagnosed with sacroiliitis and ankylosing spondylitis returns to the office for a follow-up visit. The patient reports her lower back has been stiff and swollen for the past couple of weeks. She is currently on celecoxib and ranitidine, and mentions that she had some…
CPT codes: 99214-25, 27096, J3301 x1 ICD-9: 720.2, 720.0, 787.02 ICD-10: M46.1*, M45.9*, R11.0 This encounter is coded as 99214 because it includes: Detailed history; Comprehensive examination—eight systems counted; and Medical decision making—moderate complexity (established problem, new problem with no additional workup; new prescription drug ordered). Keep in mind, the CT guidance is an inclusive…
The annual ACR State-of-the-Art (SOTA) Clinical Symposium came highly endorsed by previous fellows; therefore, upon receiving the invitation for the Fellows-in-Training (FIT) scholarship, I did not hesitate to apply. Further, the meeting was going to be held in the spring in Chi Town! Meticulously, I made arrangements with six hundred scholarship dollars at my disposal….
On July 1, 2015, the Rheumatology Research Foundation awarded more than 80 grants to a wide range of rheumatology trainees and professionals. The recipients, who submitted applications in 2014, will receive funding for essential education and training, as well as innovative research projects. Their applications were closely examined by experts in different areas of the…
There are many reasons why 15,000-plus attendees come to the ACR/ARHP Annual Meeting. For some, it’s the more than 450 educational sessions designed to boost knowledge and provide the latest information in the field of rheumatology. For others, it’s the opportunities to build connections and network with colleagues from around the world. This year’s six-day…
Full disclosure: I am not a rabid fan of dogs. None rank among my best friends. Perhaps my antipathy stems from a memorable childhood event, when I was chased down the street where I lived by a neighbor’s large and not-so-friendly hound. He seemed to be twice my size, and this explains why I may…
CHICAGO—With the approval of the Jak inhibitors (i.e., jakinibs) tofacitinib and ruxolitinib—and others being investigated—rheumatologists need to arm themselves with an understanding of these drugs so they can think critically when evaluating them and deciding how to use them, said John O’Shea, MD, chief of the Molecular Immunology and Inflammation Branch of and scientific director…
In the lead article, “Imaging in Ankylosing Spondylitis” (The Rheumatologist, April 2015), Dr. Pedersen states, “vertebral edges with MRI inflammation were three times as likely to develop new syndesmophytes than vertebral edges without inflammation (odds ratio [OR] 3.3; 95% CI: 1.5–7.4).” This statement is incorrect. An odds ratio of 3 does not imply that an…
The ICD-10 page on the Centers for Medicare & Medicaid Services (CMS) website features a countdown clock that shows the time left until Oct. 1, 2015, the date on which compliance with the new code set becomes mandatory. By the time this issue goes to press, the clock will read 90 or fewer days. Time…
When designing healthcare spaces to foster wellness, you should first understand the particular patient illness being served and then determine that population’s fundamental needs. “Providers who serve patients with rheumatoid conditions should identify the range of clinical presentations specific to their patient population,” advises Sharon E. Woodworth, AIA, ACHA, EDAC, Healthcare Practice Leader, Perkins+Will Architects,…
Editor’s note: This is the second installment of a two-part series showing how a busy office-based practice can incorporate patient advocacy into its standard workflow. In Part 1, we looked at the reasons for incorporating patient advocacy into your practice and offered an outline for implementing it. Part 2 amplifies the concepts explored in Part…
Telling a patient that he or she has been diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis, fibromyalgia or another debilitating, painful and/or chronic condition can be upsetting for a patient to hear and difficult for a rheumatologist to convey. Given this, it’s important to prepare for the appointment. “Take a few minutes beforehand to contemplate…
I have spent my entire academic career as a clinical investigator and have grown to recognize the importance of a strong and vibrant rheumatology workforce. However, I am deeply concerned about our ability as a subspecialty to sustain our research enterprise and take advantage of the modern breakthroughs in science. The reduction in federal funding…
In late February 2011, a 68-year-old woman visited the rheumatology outpatient clinic. She had been congenitally healthy and had been a field athlete in her early days. Beginning in early January 2011, she became aware of pain in her neck and both shoulders, with pain spreading to her lower back and thighs. She also became…
I found your recent article, “To Terminate or Not to Terminate?” (The Rheumatologist, April 2015), very relevant to my practice. The hospital system I practice in, Summa Health, Akron, Ohio, has two rheumatology groups with active hospital privileges. My partner and I are both part-time female rheumatologists who work for a hospital group, Summa Physicians…
Full implementation of ICD-10 will go live on Oct. 1, 2015, and congressional leaders have confirmed there will be no further delays. The transition to ICD-10 is not just a simple update; it is a major revamping of diagnosis coding. With the complexity of coding using the ICD-10 system and the high risk of disruptions…
CHICAGO—Stem cell transplantation for systemic sclerosis patients has come a long way over the past decade, with more finely calibrated dosing and better patient selection, said George Georges, MD, associate member of the Fred Hutchinson Cancer Research Center and associate professor in the medical oncology division at the University of Washington School of Medicine, Seattle,…
CHICAGO—Scleroderma patients with pulmonary arterial hypertension (PAH) might benefit from more aggressive therapy, an expert in the field said in a session on lung involvement in rheumatic diseases at the American College of Rheumatology’s 2015 State-of-the-Art Clinical Symposium in May. Newer trials—the SERAPHIN trial on macitentan, GRIPHON on selexipag, and AMBITION on an ambrisentan/tadalafil combination—show…