Discussing aching joints, sore muscles and tender limbs is all in our day’s work. We are rheumatologists; we deal in misery. But trying to parse the true meaning of these terms is among the most vexing of clinical challenges.
Diagnosis Can Be Elusive for Fever of Unknown Origin
Settling into room 501 at Maine Medical Center, Mrs. N was on her way to the bathroom when she felt it coming on. One moment she was okay; the next, her chest felt damp and cold, even as her face flushed and her temperature spiked. Her forehead glistened beads of warm sweat. She felt the…
Scleritis Often Diagnosed by Ophthalmologists, But Rheumatologists Help Determine Systemic Causes
Ophthalmologists may be more likely to initially diagnose and treat scleritis, an inflammation of the scleral tissues of the eye. However, rheumatologists need to remain aware of the condition as well: It’s commonly associated with rheumatic disorders, such as rheumatoid arthritis (RA). Scleritis can present in the eye anteriorly or posteriorly. “Anterior scleritis can be…
Respiratory-Related Mortality Higher in Men with RA
A study that found men with rheumatoid arthritis (RA) died from respiratory-related illness nearly three times as often as the general population could provide insight into possible treatment options and lifestyle changes that would help them live longer. The Study Researchers at the Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical…
What Rheumatologists Need to Know about Payer Audits
Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
Rheumatology Drug Updates: Opioid CR845 for OA Pain; RA Treatments in Development
CR845—an oral, peripherally selective kappa opioid agonist—is currently in Phase 2 trials for the treatment of pruritus, and acute and chronic pain.1 Eighty patients with hip osteoarthritis (OA) or knee OA were randomized to receive treatment with 0.25 mg, 0.5 mg, 1.0 mg or 5.0 mg CR845 twice daily for two weeks. Safety assessment, pharmacokinetics…
Ballroom Dancing Helps Improve Pharmacist’s Teaching Skills
Slow, slow, quick, quick. Don Miller, PharmD, has repeated that phrase to himself countless times over the past 40 years. Since the 1980s, Dr. Miller, a professor of pharmacy practice in the College of Health Professions at North Dakota State University (NDSU), has been a competitive ballroom dancer. Repeating that phrase is common to all…
Opinion: Paris Terrorist Attacks Shouldn’t Keep Rheumatologists from Attending Next ACR/ARHP Annual Meeting
Friday, Nov. 13, 2015. The day Paris came under attack—again. What Came Before Not even 48 hours before that day, I had said my last goodbyes: the teary eyes, the final hugs, promising to stay in touch and, perhaps, see my friends next year at the ACR/ARHP Annual Meeting. Snap and share another photo. I…
2015 ACR/ARHP Annual Meeting: Unknowns Persist Around Sarcoidosis Etiology, Pathogenesis, Treatment
SAN FRANCISCO—The Kveim-Siltzbach skin test for a diagnosis of sarcoidosis was developed in 1941, then popularized in 1961. Since then, the knowledge base about the disease has not expanded much, said Kristin Highland, MD, who has dual appointments at Cleveland Clinic’s Respiratory Institute and Orthopedics and Rheumatology Institute. “We don’t know a whole lot more…
Currier McEwen, MD, Remembered as Rheumatologist, Hybridizer of Flowers
Currier McEwen, MD, was a truly remarkable rheumatologist, accomplishing more than even the best of us could imagine. He is even more recognized in the horticulture community as a hybridizer of flowers. He was born Osceola Currier McEwen on April Fool’s Day, 1902, in Newark, N.J., and died in 2003, at the age of 101….
2015 ACR/ARHP Annual Meeting: Research Lends Insight Into Osteoporosis Treatment, New Auto-Inflammatory Disease, Scleroderma
SAN FRANCISCO—Post-menopausal women with osteoporosis, previously treated with oral bisphosphonates, had greater increases in bone density when taking denosumab compared with zoledronic acid over a year’s time, according to a study presented at the 2015 ACR/ARHP Annual Meeting. The findings were discussed in the Discovery 2015 plenary session, which focused on new research. In the…
2015 ACR/ARHP Annual Meeting: Immune Mediators Can Impact Inflammatory Response
SAN FRANCISCO—Inflammation can be either acute or chronic, and it’s the inflammatory responses that don’t shut down normally, or resolve, that cause tissue damage in rheumatic disease. “Resolution bridges the gap between acute inflammation and adaptive immunity,” said Derek W. Gilroy, PhD, head of the Centre for Clinical Pharmacology and Professor of Immunology at University…
How Rural Rheumatologists Are Coping with Passage of Affordable Care Act, Changes in Reimbursement, Payment Systems
Four years ago, a series of articles in The Rheumatologist talked about the practice of rheumatology in rural settings. Since then, changes have occurred, with the passage of the Affordable Care Act (ACA), differences in reimbursement and the trek toward value-based payment systems. One major concern expressed in the original article was the fact that…
How Rheumatologists Can Find, Develop Their Specialty Niche
Many rheumatologists chose the profession because they wanted to delve more deeply into rheumatic diseases than internal medicine calls for. “For most, this level of specialization is sufficient and worthy of a lifelong devotion and commitment,” says S. Sam Lim, MD, MPH, associate professor, Medicine and Epidemiology, Emory University School of Medicine, Atlanta. “However, some…
Hospital for Special Surgery Focuses on Measuring, Adding Value
Value is the ratio of quality to cost. The delivery and measurement of healthcare quality, however, is complex. “We first need to understand and define the health outcomes that are important to patients. Then we need to put into place care pathways that will lead to those outcomes, and finally we need mechanisms to measure…
How Villain Deaths in James Bond Movies Would Be Coded under ICD-10
Similar to other healthcare professionals, I have been required to use ICD-10 codes for the past several months. Unfortunately, I have been unable to discern any improvement in my patient care, but perhaps I have not used the codes long enough. Certainly, healthcare administrators and statisticians assure me there are several advantages of ICD-10 over…
Opinion: Role of Rheumatology Nurse Should Be Expanded
The care of patients with rheumatic diseases has undergone a great transition, with high expectations for both patients and healthcare professionals to achieve quality outcomes for the many different disorders. Integral to this goal is the development of new care models, with evolving roles for the various care providers on the multidisciplinary team.1-3 A new…
Self-Auditing Important for Rheumatology Practices
In its 2016 Work Plan, the HHS Office of Inspector General (OIG) outlined its plans for audits and evaluations of covered entities to work on creating a permanent and more structured audit program. In light of their focused effort, the Office for Civil Rights has indicated that they will concentrate on areas of high risk…
Rheumatology Coding Corner Question: Billing for Trigger Point Injection, Office Visit
A 35-year-old established female patient returns to the office for a follow-up visit for her diagnosis of fibromyalgia. She complains of pain, stiffness and swelling in her left and right shoulders and her neck. The pain is considerably worse in the morning. She denies any fever, cough or dyspnea. The physician performs a problem-focused exam….
Rheumatology Coding Corner Answer: Billing for Trigger Point Injection, Office Visit
Take the challenge. Correct Coding: 99213-25, 20552 Diagnosis: M79.70 There continues to be a lot of confusion on proper coding for trigger-point injections. Two CPT4 codes can be used: 20552—Injection(s); single or multiple trigger point(s), one or two muscle(s); and 20553—Injection(s); single or multiple trigger point(s), three or more muscle(s). The CPT4 codes are based…
Rheumatology Patients Are Essential to the ACR’s Grassroots Advocacy
Over the past several years, the ACR has collectively ramped up its advocacy efforts. Under the leadership of the Government Affairs Committee and with the combined advocacy efforts of many ACR/ARHP members and their patients, we made considerable progress advancing priority issues in 2015. With the ongoing effort of ACR members and patients, we can…
Opinion: Rheumatologists Cautioned Against Wasteful Testing to Find Rare Diseases
What rheumatologist doesn’t love the good old zebra hunt? You know—the pursuit of diagnosing the extraordinarily rare disease purely through pluck and wits. The zebra hunt is almost a tradition, a perennial topic of polite, but subtly boastful, conversation among peers and the subject of numerous career-building case reports. The hunt also happens to be…
Rheumatology Research Foundation-Funded Study Shows Promise for New RA Treatments
Joseph Holoshitz, MD, and his laboratory have made significant advances in understanding a genetic risk factor of rheumatoid arthritis (RA). This knowledge has grown into discoveries that could lead to new RA treatments in just a few years. “There was a critical point in time when we had a big idea, but funding was a…
The ACR’s Volunteer Leaders Can Help Shape Rheumatology’s Future
Margaret Mead, an early 20th century anthropologist, said, “Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.”1 The mission of the American College of Rheumatology is Advancing Rheumatology!, and it cannot be achieved without the time, effort, talent and experience of volunteer leaders. You can join…
2015 ACR/ARHP Annual Meeting: Genetic Links Emerge in Osteoarthritis
SAN FRANCISCO—As researchers have delved into the genetics behind osteoarthritis (OA), genes that appear to be players in the disease have emerged, but there have also been curveballs thrown, with expectations not always matching up to the genetic realities, an expert said at the 2015 ACR/ARHP Annual Meeting. The genetic risk of acquiring OA is…
2015 ACR/ARHP Annual Meeting: Insights into the Microbiome
SAN FRANCISCO—The organisms in the gut are remarkably malleable with diet, dangling the possibility that diseases could potentially be affected by the food that people eat, according to an expert here at the 2015 ACR/ARHP Annual Meeting. Diet Starting with studies of animal feces from zoos and from the wild, in which researchers found that…
2015 ACR/ARHP Annual Meeting: How to Identify, Manage Metabolic Myopathies & Their Mimics
SAN FRANCISCO—An athletic 19-year-old male has an episode of rhabdomyolysis, a breakdown of muscle tissue that leads to contents of muscle fiber in the blood, after weight-lifting and basketball drills. But his labs come back normal. He cuts down on his exercise, but has a second episode four months later, then finally sees a rheumatologist…
2015 ACR/ARHP Annual Meeting: Latest Clinical Literature Offers New Strategies in Lupus Nephritis
SAN FRANCISCO—Rheumatologists have to look no further than the American College of Rheumatology guidelines to know that the options for patients with lupus nephritis are sometimes not very appealing. The first-line choices are either mycophenolate mofetil (MMF) plus glucocorticoids or cyclophosphamide (CYC), also with glucocorticoids—and all of their attendant side effects. The problem: evidence, said…
2015 ACR/ARHP Annual Meeting: Skin Issues in Rheumatic Diseases Present Challenges
SAN FRANCISCO—A 40-year-old woman shows up in the clinic with scarring alopecia, with an area of hyperpigmentation on the rim of her scalp, extending from just behind the temple to behind her ears. An examination with a dermatoscope shows hyperkeratotic follicular plugging. The case—in this example, the discoid form of cutaneous lupus erythematosus (DLE)—is one…