Rheumatoid arthritis (RA) is rarely associated with renal manifestations, but secondary amyloidosis due to chronic inflammation is reported to be the etiology of renal dysfunction in many cases of RA.1,2 The discovery of biologic therapy, with TNF-alpha inhibitors in particular, made a huge difference in the disease course and prognosis of RA patients. However, TNF-alpha…
It’s been said that there is no greater bully pulpit than the American presidency. Linking the force of moral persuasion to this most powerful office—one that is capable of issuing executive orders and bypassing the wishes of Congress or rousing public opinion in favor of or against bills that are in the process of being…
Spotting the signs of autoimmunity as early as possible is often viewed as a positive goal for rheumatologic research. The premise: Patients may begin treatment years before their disease is active and destroying joints and tissue. Although much progress has been made in identifying early stages of rheumatoid arthritis pathogenesis, the clues are not as…
Sometimes, life calls for you to be out of the office for a length of time. Whether the absence is planned or not, it’s important to consider the best actions to take given the circumstances to ensure patients are cared for during your absence. Alexa Meara, MD, clinical instructor and rheumatologist, The Ohio State University…
Forty-five years ago, a computer engineer in Boston sent an electronic message between two computers some 10 feet apart. It took another 10 years or so before the electronic mail message was dubbed email—a term now, perhaps, more ubiquitous than any other in the lexicon of modern communications. Despite the seemingly definitive place email communication…
Medicine has traditionally been an apprenticeship model. The most elemental and constructive method of passing on knowledge is the mentor–mentee relational experience. Mentorship encompasses not only the role of teacher, but also that of coach, role model, advisor and confidante. Matthew J. Koster, MD, rheumatology fellow and instructor in medicine, Mayo Clinic, Rochester, Minn., can…
The serine-threonine protein phosphatase 2A (PP2A) enzyme is critical for regulatory T cells to function—without it, they don’t have the ability to suppress effector T cells and can’t protect against autoimmunity, according to new research published in Nature Immunology. Researchers found that conditional knockout mice—in which PP2A expression is knocked out only in regulatory T cells—developed…
An interdisciplinary and collaborative environment is a critical factor for the advancement of basic science and clinical research in the academic environment, says William J. Koopman, MD, former director of the University of Alabama at Birmingham’s (UAB’s) Division of Clinical Immunology and Rheumatology. And in 1977, when he was being recruited by Division Director J….
CHICAGO—In October of last year, a 52-year-old woman came to see Kevin Winthrop, MD, MPH, associate professor in infectious diseases, public health and preventive medicine at the Oregon Health & Sciences University. She had rheumatoid arthritis and was taking methotrexate and prednisone. She had had little change in her RA disease severity and was considering…
CHICAGO—When it comes to treating patients with rheumatic diseases who are in the intensive care unit (ICU), there are so many complications and considerations that few rules exist as a guide. But Paul Dellaripa, MD, associate professor at Harvard Medical School, said at the ACR’s State-of-the-Art Clinical Symposium that there are basic steps a rheumatologist…
CHICAGO—Nine out of 10 scleroderma cases include clinical signs of gastrointestinal (GI) involvement, with severe involvement associated with high mortality rates, but the pathology of this is not very well understood, a GI expert said at the ACR’s State-of-the-Art Clinical Symposium. That has left clinicians with a slate of treatments—anti-reflux, antimicrobials and prokinetics—that address only…
More than 10 years ago, New York Times journalist Thomas Friedman opined an old-world perspective that the world is, in fact, flat. In an article published on April 3, 2005, Mr. Friedman contended that “Individuals must, and can, now ask: Where do I fit into the global competition and opportunities of the day, and how…
CHICAGO—Celiac disease—the gluten-induced illness that can be seen alongside rheumatic diseases—has been seen much more commonly over the past 20 years than it was previously, but the illness can come with questions that are not always straightforward, an expert said at the ACR’s State-of-the-Art Clinical Symposium. The disease, in which the small intestine becomes inflamed…
When Christopher Ritchlin, MD, MPH, isn’t teaching students, residents and fellows at the University of Rochester Medical Center (URMC), treating patients or conducting medical research in his lab, he’s monitoring the health of another sort of patient—honeybees. For the past four years. Dr. Ritchlin, professor and chief of allergy, immunology and rheumatology at URMC, has…
The American College of Rheumatology (ACR) recognized the 50th anniversary of the Association of Rheumatology Health Professionals (ARHP) during the ACR/ARHP Annual Meeting this past November in San Francisco. The University of Arizona Arthritis Center followed up with a reception in Tucson to honor past presidents of the ARHP. The Tucson area has the highest…
Etanercept Submitted for Chronic, Severe Plaque Psoriasis in Children The U.S. Food and Drug Administration (FDA) has accepted the supplemental Biologics License Application for etanercept (Enbrel) for treating pediatric patients with chronic, severe plaque psoriasis.1 The application was submitted in early January 2016 and is based on results of a one-year Phase 3 study with…
Take advantage of the opportunity to have your work peer reviewed by experts in the field. If accepted, your abstract will be published in a special online supplement of Arthritis & Rheumatology and presented at the 2016 ACR/ARHP Annual Meeting in Washington, D.C., Nov. 11–16. All abstracts must be submitted online by noon ET on…
The Rheumatology Research Foundation recently received its seventh consecutive four-star rating from Charity Navigator. This prestigious, highest rating possible is based on good governance, sound fiscal management and commitment to accountability and transparency. As the nonprofit sector continues to grow at an unprecedented pace, savvy donors are demanding more accountability, transparency and quantifiable results from…
With limited time to spend away from your practice, you can still have an impact on issues important to Advancing Rheumatology! Below are several ways to have your voice heard, without ever leaving town. Set Up a Local Meeting with Your Elected Officials Every member of Congress has at least one local office in the…
It is no secret that payers and providers have conflict as it relates to reimbursement rates for medical services, and there is another stakeholder, the patient, that plays an important role in the financial impact of healthcare reimbursement. Usually, patients are faced with unforeseen bills from their providers due to an unpaid portion of a…
A 67-year-old female patient with Medicare returns to the office for a follow-up of her age-related osteoporosis. She states she has an achy pain in her left hip that lasts for 30–40 minutes in the morning. Currently, she has taken ibandronate sodium and alendronate sodium for the past year, and her pain level is a…
Take the challenge. CPT: 99213-25, 77085 ICD-10: Diagnosis M81.0, Z79.52 The encounter is coded as 9913 as follows: History—The history of the present illness was extended. The review of systems was complete, and the past medical history was documented. This makes the history detailed. Examination—The examination was expanded problem focused. Medical decision making—The diagnosis was…
I read with interest the Diagnostic View (TR, April), which, according to the authors, represented a case of rhupus, an overlap syndrome of RA and SLE. I challenge this view. My arguments: In the case of erosive RA, typically erosive changes are seen at MTP joints other than MTP1 (e.g., MTP5). In addition, the erosive…
I’m writing in regard to the article, “Fever of Unknown Origin” (TR, March 2016), by Charles Radis, DO. In regard to the non-caseating granulomas, there was no mention of epithelioid or giant cells. In addition, it was mainly [complement] C4 in the center of the granulomas, which is often found in sarcoidosis. Moreover, whether these…