A 52-year-old man living in greater Boston with a history of hypertension presented at our rheumatology clinic with bilateral knee pain and swelling. He had been in his usual state of health until four months earlier when he developed right knee pain and swelling without an incipient trauma, which did not improve with non-steroidal anti-inflammatory…
I knew I was about to be schooled. That’s what I thought when I first started to read the Twitter feed of Erin D. Michos, MD, MHS, an associate professor of medicine in the Division of Cardiology at Johns Hopkins University, Baltimore. I have a Twitter account, but as a general rule, I use it…
In the first scene of the Broadway stage adaptation of Harper Lee’s To Kill a Mockingbird, young Scout contemplates two words she has heard in the courtroom: “All rise,” and wonders if they really are meant to elevate the minds of all those present for the proceedings. That instruction—“All rise”—serves as a leitmotif throughout the…
A 53-year-old man was hospitalized for pericarditis, abdominal lymphadenopathy of unknown origin and non-bloody diarrhea. He was admitted for four days, and then he was discharged home without incident. Two months after his initial presentation, he was readmitted for the evaluation of several new issues, including symmetric arthralgias, hypovolemia with associated electrolyte abnormalities and concurrent…
WASHINGTON, D.C.—Dozens of rheumatology leaders met with more than 100 politicos on Capitol Hill in mid-May as part of the ACR’s annual Advocacy Leadership Conference. Armed with research and advocacy training concerning a handful of important issues, rheumatologists, rheumatology interprofessional team members, government affairs specialists and others met with federal lawmakers, legislative aides and correspondents….
What attracts physicians to a career in rheumatology? Traditionally, the foundation of clinical training at both the medical student and house staff level is based on inpatient services. There are many reasons for this, predominantly revolving around access to patients available for teaching. The result: Trainees are predominantly exposed to a group of conditions that…
Colombia is a beautiful country with a rich cultural history that has made many social advances over the past decades. I was privileged to spend a month rotating with rheumatologists in San Vicente de Paul Hospital in Medellín, the City of Eternal Spring. As part of the ACR and the Pan American League of Rheumatology…
Research in type I interferon (IFN) driven mouse models of systemic lupus erythematosus (SLE) suggests the microbiome may play a role in the development of autoimmunity. Additionally, changes in diet may induce protective effects in the gut.1 “Microbes in the gut worsen a lupus model related to the interferon pathway,” says Martin A. Kriegel, MD,…
Are outcomes better in a specialized lupus clinic compared with care provided in a general rheumatology setting? New research from Rush University, Chicago, studies this important care management question and finds the specialized clinic does indeed produce better outcomes.1 A big part of the difference may be due to the added experience specialty clinic clinicians…
Interstitial lung disease (ILD) can be associated with rheumatoid arthritis (RA) with significant morbidity and mortality. An article in The Journal of Rheumatology focused on calculating the prevalence, incidence, mortality and costs to the healthcare system of RA-related ILD (RA-ILD).1 “RA is the most common of connective tissue diseases encountered by rheumatologists—affecting about 1% of…
Many, if not all, rheumatologists seek to grow as clinicians so they can provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In The Rheumatologist’s Lessons from Master Clinicians series, we present insights from clinicians who have achieved distinction in the field of rheumatology and who are respected by…
Type I interferon appears to play a role in disease susceptibility and pathogenesis in several classic connective tissue diseases, at least in some patients. Below, I present evidence supporting this connection, explore potential missing links in pathogenesis and discuss biological treatments that target the pathway. The Type I Interferon Pathway Interferons are a class of…
When Liz Morasso, LCSW, facilitates a Families Living with Rheumatic Diseases support group at Children’s Hospital Los Angeles, she empathizes with the struggles and challenges of her young patients. Ms. Morasso was only 16 years old when she was diagnosed with both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). She knows all too well…
CHICAGO—Rheumatologists often come to Brian Schwartz, MD, associate professor of medicine and vice chief for clinical affairs in the Division of Infectious Diseases, University of California, San Francisco, with a concern: A patient on immunosuppression has a family member who needs a live vaccine, but the patient may be vulnerable to the vaccine’s effects. Should…
CHICAGO—The world of rheumatology is beginning to harness the promise of the microbiome, with evidence showing components of the gut may help predict response to medication and may be manipulated to improve how well a treatment works, said Jose Scher, MD, at the 2019 ACR State-of-the-Art Clinical Symposium, held April 5–7. “We can truly exploit…
CHICAGO—Choosing a treatment for antiphospholipid syndrome (APS) involves an array of factors, from the antibodies present to their titers to other risk factors, said Lisa Sammaritano, MD, during a guided tour of APS treatment at the 2019 ACR State-of-the-Art Clinical Symposium, held April 5–7. Dr. Sammaritano, associate attending physician at the Hospital for Special Surgery,…
CHICAGO—When Richard Furie, MD, was first asked to speak about lupus at the 2019 ACR State-of-the-Art Clinical Symposium, held April 5–7, organizers suggested he discuss low disease activity and classification criteria. But Dr. Furie, a professor of medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y., and a veteran investigator…
CHICAGO—Although medical treatments for addiction have been proved effective, they are not used often enough, said Kenneth Stoller, MD, during a session at the 2019 ACR State-of-the-Art Clinical Symposium, held April 5–7. These treatments bring health benefits that extend beyond addiction, he said. Dr. Stoller, assistant professor of psychiatry and behavioral sciences at Johns Hopkins…
When Reshma Khan, MD, a rheumatologist at the Family Arthritis Center, Jupiter, Fla., relocated from Michigan three-and-a-half years ago, she missed the camaraderie and friendships she’d made in Michigan. “I’m a very social person, and after finishing my research, residency and fellowship in Michigan, I missed those close friendships [when I moved to Florida],” Dr….
A senior rheumatologist with extensive experience in the management of systemic lupus erythematosus is asked to help draft clinical guidelines for the treatment of lupus nephritis. Neither she nor her family members receive grant funding nor does she consult with any pharmaceutical or biotechnology companies. She does have strong clinical opinions based on current evidence…
In a 24-month clinical trial, tofacitinib proved safe and effective in combination with methotrexate in adult patients with RA…
A study comparing seven biologic DMARDs in RA patients aged 65 years and older found abatacept had the highest retention rate and the lowest discontinuation rate…
On July 1, 2019, the Foundation awarded more than 80 grants to a wide range of rheumatology trainees, professionals and institutions. The recipients will receive funding for essential training and career development, as well as for innovative research projects. Their applications were closely examined by experts in different areas of the field to ensure awards…
Step therapy (or fail first) policies introduce significant barriers to access to effective treatments for patients with rheumatic diseases. They also impose significant administrative and cost burdens on providers and practices. The ACR and ARP are advocating state governments, Congress and regulatory agencies limit the impact of these policies on access to care by creating…
Has your practice recently hired a nurse practitioner (NP) or physician’s assistant (PA) to help provide care to a growing patient population? Are you considering hiring, but unsure if you have the time or resources to adequately train someone new to the specialty? The Training Rheum is designed to give your professional staff a solid…
Denied claims represent unpaid services, or lost or delayed revenue. Avoiding claims denials is the responsibility of everyone in a practice. Any deficiency on a focused strategy for denials management will have unfavorable resolutions to denials or lead to writing off the service without payment. With the changing landscape in practice management, the best route…
A 68-year-old patient reports that her eyes have been itchy and red for approximately one month. She was treated with erythromycin gel on Jan. 10; while the itching did not stop, the redness resolved. She denies any matting and has not used any other type of eye drops. She states there has been no change…
Take the challenge. Answer: This is a two-part office visit scenario. The first part of the scenario illustrates the original new patient office visit, and the second portion is for the follow-up, interprofessional telephone consultation with the patient’s ophthalmologist. For the office visit … CPT: 99203 ICD-10: B30.8, M45.5, I73.00 The history was detailed, because…