How do you ask a new patient about sex and gender—or know which pronoun to use? Keep the conversation straightforward and respectful to put everyone at ease, says Morgan Orndorff, a transgender man who works as an administrator at a major academic medical center. “Everyone is a little different in terms of their sensitivity level”…
“Wait. I can explain.” One could imagine this phrase coming up under many conditions in daily life. When I first became a physician, however, I would never have expected to use this phrase in my clinic. In medical school, I was taught the importance of dialogue in establishing a relationship with a patient. Statistics indicate…
The underlying tenet of the ACR’s advocacy efforts is that we cannot effect change for our profession and our patients unless we take our issues directly to decision makers. As I write this column, I am highly encouraged by the progress we have made so far this year in the advocacy realm. At the same…
Robert Finberg, MD, chair of medicine at the University of Massachusetts (UMass) in Worcester, describes Ellen M. Gravallese, MD, as one of a dying breed: a quadruple-threat physician who excels in basic science research, clinical care, teaching and administration. Dr. Gravallese holds the Myles J. McDonough Chair in Rheumatology, is professor of medicine and serves…
If you had asked Ray Waldrup in 1981 what he would be doing in 2018, serving as the CEO of the largest rheumatology practice in the U.S. would probably not have been his first guess. Back then, as a young college student in Georgia, Mr. Waldrup took a job at a national jewelry retailer and…
Preventing adverse outcomes in individuals who have rheumatic diseases is a daily goal for rheumatologists. For example, rheumatologists prescribe medications and perform screening to prevent erosions in rheumatoid arthritis (RA), renal failure in systemic lupus erythematosus and flares across all diseases. Many of these actions are classified as secondary or tertiary prevention, because individuals have…
Patients with a specific genetic predisposition for rheumatoid arthritis (RA) may want to take precautions when consuming certain types of meat, dairy and produce grown with cow manure, according to a new study out of the University of Central Florida (UCF) in Orlando. The study, which assessed 100 RA patients, published in the journal Frontiers…
Granulomatosis with polyangiitis (GPA) was first described in the British Medical Journal in 1897 by Scottish otolaryngologist Peter McBride.1 GPA is a relatively rare, systemic necrotizing vasculitis that can make diagnosis challenging. The incidence has been estimated anywhere between two and 12 cases per million.2 GPA mainly affects adults between the ages of 45 and…
After total hip or knee arthroplasty, flares are common in patients with rheumatoid arthritis (RA), according to a recently published study.1 Higher disease activity at baseline appears to be linked to flares, but use of such medications as biologics and methotrexate did not independently predict flaring. “Contrary to the notion that patients with established RA…
Over the past several decades, the medical community has been moving toward a model of shared decision making. In addition to its ethical advantages, shared decision making potentially yields such benefits as improved medical adherence and better health outcomes. With the proliferation of treatment options and changes in the larger culture, shared decision making is…
A recent position statement by the Society of Behavioral Medicine (SBM) concludes that patients with persistent pain need better access to psychosocial care in all healthcare settings.1 The SBM offers 10 health policy recommendations for improving such access, including removing system-related barriers, providing referral tools, reimbursing for evidence-based psychosocial approaches, prioritizing generalist-level and specialist pain…
Behçet’s disease is a chronic, relapsing and remitting vasculitis with multisystem involvement. Commonly referred to as the Silk Road disease due to its prevalence in the Asian and Mediterranean region of the traditional Silk Road, Behçet’s was first described by Hippocrates as a triad of symptoms—genital and oral ulcers with uveitis—and attributed to links with…
CHICAGO—The promise of precision medicine—the tailoring of treatment to a given patient based on genetics and other factors—has probably been best illustrated in oncology, with therapies targeted specifically to markers expressed on tumors. But rheumatology is in the thick of precision medicine as well, said Judith James, MD, PhD, chair of the arthritis and clinical…
CHICAGO—As good an option as hydroxychloroquine (HCQ) is for many patients with rheumatic diseases, such as rheumatoid arthritis and especially lupus, safety must be an important consideration, an expert said at this April’s ACR State-of-the-Art Clinical Symposium. The use of the antimalarial has become a controversial subject, with clinicians trying to balance the drug’s disease-modifying…
CHICAGO—Neonatal lupus is a rare disorder, but its onset can be dramatic, and it can be fatal. Clinicians must be armed with information to manage it and help guide parents through difficult decisions, an expert said in April at the State-of-the-Art Clinical Symposium. Despite the name, neonatal lupus does not mean that either the mother…
CHICAGO—High eosinophil counts that can’t be explained should concern rheumatologists and spark attempts to identify what’s happening, an expert said at the ACR State-of-the-Art Clinical Symposium in April. “Eosinophil counts over 1,500 (per microliter) should provoke worry,” said Bruce Bochner, MD, professor of medicine in allergy and immunology at Northwestern University Feinberg School of Medicine…
CHICAGO—A 75-year-old woman with low bone density, who has had a fracture and has other risk factors for fracture, is treated with the bisphosphonate alendronate. After five years on the drug she comes back, wondering: Should I stop taking the drug? She’s had no additional fractures. Her bone density has improved, but her lumbar spine…
CHICAGO—As Eric Ruderman, MD, professor of medicine in rheumatology at Northwestern University Feinberg School of Medicine in Chicago, began his talk on psoriatic arthritis treatment at the ACR State-of-the-Art Clinical Symposium in April, he marveled a bit at how much there was to cover. Drugs gaining prominence in the treatment of rheumatoid arthritis and dermatological…
In addition to the classroom and exam room, the other room Joseph Flood, MD, enjoys spending time in is the kitchen. With a mother who worked as a local tavern cook and a policeman father who enjoyed preparing tasty meals as much as arresting bad guys, Dr. Flood, a rheumatologist at the Columbus Arthritis Center…
Lurie Prize Goes to Autoimmune Researcher Zhijian “James” Chen, PhD, is this year’s recipient of the Lurie Prize in Biomedical Sciences for his 2012 discovery of the enzyme cyclic GMP-AMP synthase (cGAS). Dr. Chen received the prize at the Foundation for the National Institutes of Health Award Ceremony in May. His work revealed the paradoxical…
For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…
After an independent review, ongoing clinical trials investigating the safety of fasinumab for treating hip or knee OA will discontinue the use of higher fasinumab doses…
The FDA Arthritis Advisory Committee has recommended the approval of 2 mg baricitinib (but not in a 4 mg dose) for treating adults with moderate to severe active RA…
In the coming fiscal year (July 1, 2018–June 30, 2019), the Rheumatology Research Foundation has committed to fund more than $9.4 million in rheumatology research and training. Approximately half of the awards will support efforts to recruit and train the next generation of rheumatology professionals. The remaining funds will be awarded to advance research projects…
Attended by over 15,000 rheumatology professionals from over 100 countries, the ACR/ARHP Annual Meeting is the largest rheumatology meeting in the world and the premier educational event for physicians, health professionals and scientists who treat or research rheumatic and musculoskeletal diseases. The 2018 Annual Meeting will be held Oct. 19–24 in Chicago. Attendees will be…
On May 16 and 17, ACR/ARHP leaders serving on the Board of Directors, Affiliate Society Council, Government Affairs Committee, Committee on Rheumatologic Care, RheumPAC Committee and Insurance Subcommittee once again went to Capitol Hill to advocate on behalf of ACR/ARHP members and their patients. The group represented 27 states and the District of Columbia, and…
Audit activity among Medicare and most third-party payers has increased in response to pressure to reduce healthcare costs. The return of billions of dollars to Medicare, Medicaid and third-party programs through these medical audit reviews has also increased. For example, the Government Accountability Office (GAO) 2014 Annual Report estimated that the Centers for Medicare &…
A 73-year-old female established patient with rheumatoid arthritis affecting multiple joints and with positive rheumatoid factor returns to the office for an infliximab infusion. She denies any fevers, cough, dyspnea or concurrent illness. She has joint pain of 6 on the pain scale. She is on an NSAID, weekly methotrexate subcutaneous injections, folic acid and…
Take the challenge. CPT codes: 96413, 96415, 96375, J1745x30, J1200x1 Diagnosis ICD-10: M05.79 With the total infusion time of two hours and 13 minutes, CPT code 96413 is used to code for the first hour of the infusion and 96415 for the additional hour. The infusion would have to be 31 minutes into the next…