Non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs for acute and chronic pain. More than 30 billion doses of NSAIDs are consumed annually from more than 70 million prescriptions.1 Despite their common use, NSAIDs are not free of serious toxicities. In the pre-Vioxx (rofecoxib) era, gastrointestinal toxicity was the primary concern for many NSAIDs….
Picture this: It’s 3 o’clock in the morning. You can’t sleep. You settle in front of the television to watch a rerun of Dirty Dancing. And then it hits you: Ask your doctor. Even as your eyelids sag, some part of your primitive forebrain snaps to attention. Medical training has turned us all into multitaskers,…
The ACR and the ARHP have a long, rich history of collaboration, spanning close to 25 years together. Our predecessors saw the value of an interprofessional team and having an organization that brings together a vast number of constituencies. The result was these two organizations coming together in 1994 when the ARHP became a division…
Rheumatoid arthritis (RA) is characterized by polyarthritis, especially involving hands and wrists. Without treatment, RA usually evolves to articular deformities. Unfortunately, although rheumatoid deformities are characteristic, they are not pathognomonic, and we should be aware of possible mimics.1 Neuropathic arthropathy (NA), similar to other diseases, such as hemochromatosis, psoriatic arthritis, calcium pyrophosphate deposition disease, Jaccoud…
A 43-year-old man with a past medical history of type 2 diabetes mellitus, bilateral inguinal hernia repair as a child and prior cholecystectomy woke from sleep with sudden-onset periumbilical abdominal pain. He was admitted to another hospital, but required transfer to our surgical intensive care unit after a recurrent episode of severe abdominal pain, during…
Many rheumatology patients have complex conditions and require the added expertise of colleagues in other fields, such as pulmonology, neurology or dermatology. This is even more true when patients with complex care issues are referred to academic medical centers. At such centers, patients often travel hours for an appointment and see more than one provider….
Through much of the 20th century, dedicated rheumatic disease units were found in hospitals across the U.S. and countries around the world. In the latter part of the century, this began to change, with hospitals moving toward the consult model of care for rheumatic patients. This change reflects larger shifts in the medical world toward…
Each fall, the ACR/ARHP Annual Meeting takes place in a major U.S. city. More than 15,000 people fill the cavernous halls of the area convention center and nearby hotels to attend scientific and educational sessions, scan the latest data on posters and mingle with colleagues at the annual Presidents’ Reception. What most attendees may not…
Responding to the Trump administration’s drug pricing proposals, the ACR released a set of principles it hopes will help guide any drug policy changes.1 The principles underscore what is critically needed for rheumatologists to provide the best and safest care to their patients, many of whom require ongoing treatment for chronic conditions. “The ACR has…
A recently published research review notes physician burnout has become a crisis in the U.S. The authors describe how the added administrative tasks of electronic health records (EHRs) have contributed to the crisis, as well as how regulatory requirements and EHR platform design exacerbate the situation…
Fifteen women and men seated around a conference table in a New York City hospital listen intently to one of their peers. A 40-year-old elementary school teacher shares her challenges related to the intersection of rheumatoid arthritis (RA) and the responsibilities of a demanding job.* With the support and counsel of fellow group members, the…
With extensive clinical trial data being published daily, how does a rheumatologist stay up to date on latest breakthroughs? Rheumatologists can leverage multiple online resources to stay informed and apply information to patient care…
Technology in medicine is no longer new or trendy. It’s pervasive. Rheumatologists may now assume a patient has searched online for information about his or her diagnosis or potential therapies. Both physicians and rheumatology health professionals should acknowledge their patients’ Internet surfing and find out what they’ve read, says Betsy Roth-Wojcicki, RN, MS, CPNP, an…
The past five years have been busier than usual for the Churg-Strauss syndrome. It was renamed eosinophilic granulomatosis with polyangiitis (EGPA).1 Longitudinal cohorts totaling 484 patients—approximately as many as all previous series combined—were described.2,3 A proposal was advanced to remove and rename a subset in which vasculitis may not be present.4 And shortly after the…
When Jeanne Scott first entered nursing school, she planned to become a women’s health nurse practitioner. She was not expecting her final clinical placement in rheumatology to change the entire course of her career. “Truthfully, I did not understand what rheumatology practitioners did until this introduction to the field,” says Ms. Scott, who describes being…
Rheumatological diseases can be complex, so how can those within the specialty help ensure information about rheumatology shared by the media is accurate? Cue the ACR/ARHP Experts on Call program, which is designed to connect rheumatology health professionals with journalists looking for subject matter experts. Experts on Call is managed by the ACR’s Public Relations…
I am an alien rheumatologist. Are you? One in five rheumatology fellows is considered an alien. Under the Code of Federal Regulations Title 22 Chapter I Subchapter G Part 62 Subpart B Section 62.27, an alien physician is a foreign national who is a graduate of a school of medicine who comes to the U.S….
Understanding rheumatic and musculoskeletal diseases (RMDs) is an understandably tall order for the lay public, what with the huge number of conditions and the complex—and often little understood—processes involved. Now, a working group of the European League Against Rheumatism (EULAR) and the ACR has set out to try to correct this problem with a definition…
Many patients with rheumatoid arthritis (RA) report pain despite excellent control of inflammation with immunotherapies. Variable degrees of coexisting fibromyalgia (FM) may explain this disparity. RA patients who have the highest 2011 ACR FM survey criteria scores appear to share neurobiologic features consistently observed in FM patients. This study is the first to provide neuroimaging evidence that RA is a mixed pain state, with many patients’ symptoms being related to the central nervous system rather than to classic inflammatory mechanisms…
As if the fatigue, joint pain, etc., were not enough, new research has found many lupus patients must contend with clinical depression as well—something that can have a devastating cascade effect on other areas of their lives. Are adults with childhood-onset lupus at greater risk of depression than lupus patients with onset of disease during…
Videos designed to help patients understand and manage chronic rheumatologic diseases can lead to gains in clarity about the disease duration, symptoms, medications, and the importance of regular visits with a physician. A study published in a recent issue of Arthritis Care & Research looks at the development and impact of three educational videos for…
Although total knee replacement (TKR) surgery can improve pain and function in individuals with knee osteoarthritis (OA), many patients who are sedentary before undergoing TKR don’t increase their physical activity levels after surgery. A new study led by Elena Losina, PhD, of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital in Boston, examined…
A recent analysis of the monoclonal antibody epratuzumab finds new evidence for its effectiveness in a subset of systemic lupus erythematosus (SLE) patients who have a concurrent diagnosis of Sjögren’s syndrome, a progressive autoimmune disease that affects exocrine glands and is characterized by dry eyes and mouth.1 Sjögren’s can be primary, meaning independent of other…
A phase 3 clinical trial in which researchers treated lupus patients with blisibimod, a biologic treatment that inhibits B cell activating factor (BAFF), did not meet its primary endpoint, but did demonstrate evidence of possible efficacy. Researcher Joan T. Merrill, MD, a member of the Oklahoma Medical Research Foundation (OMRF) and OMRF professor of medicine…
Could relief for rheumatoid arthritis (RA) symptoms be as close as the nearest seafood restaurant? Possibly, say researchers from Harvard. University who recently conducted a cross-sectional study. Published in the March issue of Arthritis Care & Research, the research examined whether consuming fresh fish could ease RA symptoms.1 Previous studies have examined the role fish…
Patients who reviewed an industry-sponsored booklet about a commonly used rheumatoid arthritis drug were twice as likely to choose the proposed therapy as were patients who reviewed similar decision-aid material presented in a neutral manner, according to a recent study. Richard Martin, MD, MA, professor of medicine, rheumatology, at Michigan State University College of Human…
BALTIMORE—Rheumatologists may not think about osteoporosis on a daily basis, but they should, said Dr. Karl Insogna, the Ensign Professor of Medicine at Yale University School of Medicine and director of the Yale Bone Center in New Haven, Conn., in his recent lecture at the Maryland Society for the Rheumatic Diseases. With approximately 75 million…
CHICAGO—When a patient with rheumatic disease suffers recurrent infections, has a history of multiple autoimmune diseases or presents with atypical autoimmune syndromes, clinicians should consider the possibility of an immune deficiency, an expert said at the ACR State-of-the-Art Clinical Symposium in April. W. Winn Chatham, MD, professor of medicine at the University of Alabama at…
CHICAGO—About 30 years ago, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) began to outpace renal crisis as the main causes of death in scleroderma (SSc). But treating these lung complications has proved vexing for clinicians. There is no easy way to predict who will develop PAH. There is no telltale antibody and no…
CHICAGO—The placebo effect in treating pain in osteoarthritis (OA) should not be discounted, an expert said at the ACR State-of-the-Art Clinical Symposium in April. It’s especially important to accept the effect as real considering that trials of pain therapies in OA generate such high placebo effects (typically at least 40%) and that OA treatment options,…
CHICAGO—Amid what she called a “dizzying array of choices” for rheumatoid arthritis (RA)—from anti-TNF and anti-IL6-receptor therapies to B cell depletion to new biosimilar options—disease treatment should still revolve around several basic concepts, an expert said at the ACR State-of-the-Art Clinical Symposium in April. Joan Bathon, MD, chief of rheumatology at Columbia University in New…
Every single morning—even on weekends—Robert W. Simms, MD, wakes up at 3:45 and is out the door by 4:30 to swim, run or cycle for at least one hour. After weekday workouts, he then heads to his job at Boston University (BU) School of Medicine, where he serves as professor of medicine and rheumatology section…
A 67-year-old man with a recent onset of diffuse muscular pain and stiffness and an erythrocyte sedimentation rate of 55 is referred to you by his family practitioner. He has a history of non-insulin-dependent diabetes mellitus, but no history of headaches or swollen joints. He has chronic back pain, has had two surgeries and was…
On the basis of data from multiple clinical trials, the FDA has approved certolizumab pegol for treating moderate to severe plaque psoriasis…
Ixekizumab is the first agent approved by the FDA for treating plaque psoriasis to include labeling for psoriasis in the genital area…
On July 1, the Rheumatology Research Foundation awarded grants to a wide range of rheumatology trainees and professionals. The recipients 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 field to ensure awards went to the most promising…
Join us in Chicago for the 2018 ACR/ARHP Annual Meeting on Oct. 19–24. Register now to save; advance registration rates end Oct. 3. High-Impact Learning Starts with Pre-Meeting Courses Pre-meeting courses offer attendees unique learning opportunities in specific topic areas. The pre-meeting courses will be held at McCormick Place Oct. 19–20. No matter your area…
You can now use the updated Centers for Medicare & Medicaid Services (CMS) MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-Based Incentive Payment System (MIPS). Enter your National Provider Identifier (NPI) in the tool to find out whether you need to participate during the 2018 performance year. Changes to…
The ACR’s Collaborative Initiatives (COIN) department develops and tests innovative solutions for complex rheumatology care problems. “All of the work COIN does—programs toward health equity, creating models to increase rheumatology-related capacity in places of need, building bridges with local and national patient organizations—is done on [behalf of its members],” says Dr. David Daikh. Each month…
Evaluation & Management Documentation Quiz What element drives an evaluation and management (E/M) visit? The chief complaint in the patient’s own words of why he or she is in the practice for that date of service. The presenting problem(s) being discussed with the physician for that patient during the visit. The examination performed on the…
Take the challenge. B—The presenting problem(s) is what is evaluated during the history and examination by the provider. The chief complaint is in the patient’s own words or is a follow-up for his or her current condition. The history of present illness, along with the review of systems, usually guides the provider through the examination….
The adage frequently cited in healthcare settings, “If it isn’t documented, it wasn’t done,” still rings true for the key components required in a patient’s medical record. The note in the medical record must sufficiently describe all of the services furnished to patients on a specific date. The essential requirements to appropriately bill a claim…