Millions of adults suffer from painful knee osteoarthritis (OA). Although physical activity can help improve pain and reduce functional limitations, many people with OA are physically inactive. For people living with knee OA, it can be difficult to get started with or continue on a physical activity program, because pain and other symptoms can make…
Dr. Sheffield is an adult rheumatologist who received the following referral request from a family doctor: “Please see this 22-year-old male with a history of juvenile arthritis for ongoing care. I have only seen him once, and have no previous medical records.” Dr. Sheffield meets with Paul, who reports that he has had arthritis since…
Rheumatologists and rheumatology health professionals make a difference every day in the lives of patients. And through the work of many devoted members, the College takes that commitment beyond the care setting and into the policy arena to Advance Rheumatology! on Capitol Hill and in state capitols across the country. I want to take a…
Tuesday, Jan. 20, a busy morning lay ahead for the staff of the cardiovascular surgery clinic. There were several new patients to see. No doubt, many of them were anxious to hear whether the skills of the surgeons they were going to meet could help them live another day. There were countless follow-up visits and…
In late March 2012, I awoke with pain in my left hand. I had difficulty moving my metacarpophalangeal (MCP) joints. They did not move smoothly, but clunked. As I repeatedly attempted to open and close my hand, I realized that I had morning stiffness. As the pain and stiffness gradually improved over the next hour,…
Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in Southeast Asia and northern Australia.1 In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare, but well-recognized, manifestation of melioidosis. Case Report A 49-year-old woman with known diabetes was admitted elsewhere with uncontrolled diabetes and fever. She was found to…
At the 2014 ACR/ARHP Annual Meeting in Boston, the Rheumatology Research Foundation staff sat down with a few ACR and ARHP members to get their take on what the Foundation’s 30th anniversary means to them. We spoke with current and former leaders of the Foundation and the ACR, as well as numerous Foundation award recipients,…
The classic American social studies lesson is How a Bill Becomes a Law, but a more pertinent lesson for U.S. rheumatologists today may be How a Dollar Bill Becomes a PAC. This article is a nuts-and-bolts primer on how exactly RheumPAC works. The purpose is to inform readers about how and why to participate. Money…
The Case A 68-year-old woman with a past medical history of Charcot-Marie-Tooth presents with thickening of the skin on her trunk and extremities, which she has had for the past seven months (see Figures 1 and 2). Her symptoms first began with swelling of her bilateral upper and lower extremities. She is now having difficulty…
Biomarkers for RA I read the article, “Finding Biomarkers in RA Remains Elusive Goal” (February 2015 The Rheumatologist), with great interest. The author correctly identifies the multi-biomarker disease activity assay (MBDA; Vectra DA) as a potential biomarker that identifies RA patients at risk for radiographic progression. The author names a study presented at the 2014…
Squeeze Test in Inflammatory Arthritis, Need for Standardization? The first use of the squeeze test as a clinical maneuver to detect inflammatory arthritis in patients with hand problems was described by Recth in 1988, and Morton described its use for patients with foot problems.1,2 In 1991, Eberhardt and Rigby proposed the clinical maneuver be used…
In today’s busy rheumatology practices, the services of nurse practitioners, physician assistants, occupational therapists and clinical nurse specialists are a great asset for patient flow, as well as increased revenue. As the growth of nonphysician providers (NPPs) in rheumatology practices has evolved, it has become increasingly important to understand the incident-to rules and avoid the…
The word rheumatology and its counterpart, rheumatologist, are new to the English language. They didn’t exist 50 years ago. There were a relatively few physicians interested in rheumatologic disease, but not the science of rheumatology. The American College of Rheumatology was founded in 1988. A few of us still alive, notably, the centenarian Ephraim Engelman,…
What started out as a way to bring specialty medicine to rural areas around 40 years ago has evolved from sharing imaging and laboratory results to seeing and interacting with patients remotely. Telemedicine is beginning to evolve from its traditional urban–rural linkage, and rheumatologists are following along. “Telemedicine covers a variety of services, but it…
Dramatic changes have occurred over the past 50 years in rheumatology practice and management. As an integral part of the healthcare team, the rheumatology nurse must navigate these changes and the advancements in treatment options and care available for patients with rheumatic disease. Rheumatology nursing was recognized as a nursing specialty by the American Nurses…
As the literature on comorbidities linked to psoriatic arthritis (PsA) expands, it’s becoming more difficult for clinicians to keep up with what comorbidities should be assessed and how these comorbidities affect treatment selection. Given this, rheumatologists at the Perelman School of Medicine at University of Pennsylvania, Cleveland Clinic and Hospital for Special Surgery in New…
As a physician, it’s important to be in the present 100% of the time. “Writing the wrong number on a prescription pad is an extreme, but important, example of what could happen if a physician is distracted,” says consultant Donna Singer, Donna Singer Consulting LLC, Newton, Mass. Sanjay Chabra, DO, director of rheumatology, St. Jude…
Maura Daly Iversen Named Catherine Worthingham Fellow by APTA Maura Daly Iversen, PT, DPT, SD, MPH, FNAP, FAPTA, associate editor of The Rheumatologist, was recently named a Catherine Worthingham Fellow—the highest honor among the American Physical Therapy Association (APTA) membership categories. According to the award announcement, Worthingham “motivated others to make an impact within the…
Sidney R. Block, MD, has practiced rheumatology in Maine since 1975, where he now lives on the coast in Northport. He has received the Paulding Phelps Award and been recognized as a Master by the American College of Rheumatology. He is also a lay cantor for the Jewish reform congregation in Bangor, which he helped…
The first biosmilar products have been approved in the U.S. and Canada, following Europe’s early lead. Canada approved its first biosimilar monoclonal antibody (mAb) therapy, known as Inflectra (infliximab), on March 30, 2015.1 In Canada, biosimilars are being called subsequent entry biologic (SEB) agents. Inflectra is approved for treating patients with rheumatoid arthritis (RA), ankylosing…
Scleroderma is a rare rheumatologic autoimmune disease that affects the skin and can also affect other organs. Due to excess formation of scar tissue, blood flow to the extremities is decreased, primarily to the hands, and tissues often become hypoxic, resulting in sclerodactyly and proximal skin involvement.2 The incidence of scleroderma in the U.S. is…
In 1984, I wrote my first prescription for the antimalarial drug, hydroxychloroquine (Plaquenil), for a 28-year-old woman with SLE. She was considerably overweight, with inflammatory arthritis and a photosensitive rash, and I worried that oral corticosteroids would tip her over into diabetes. I presented the case to my attending, Steven Malawista, MD, at the Yale…
Incident-to Billing Case Scenario A 51-year-old female patient returns for a follow-up visit with a physician assistant (PA) for unilateral primary osteoarthritis of her right knee. She had an intraarticular corticosteroid injection of her right knee six weeks prior to her visit. She reports significant improvement in her knee pain and stiffness, and states the…
Diagnoses: ICD-9 715.16, 528.02, E943.8 ICD-10 M17.11, K12.32, T39.395A This was an established patient visit with a new diagnosis. Because the PA sought out the physician to address the new problem and document the assessment and treatment, the visit can still be billed as incident-to. Note: The physician initiated the plan of care for treatment…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History These images were taken of an 85-year-old female with a one-year…
View the question. Transverse (see Figure 1) and longitudinal (see Figure 2) ultrasound images show an anechoic collection (asterisks), which surrounds the distal biceps tendon (b). The collection is compressible (not shown here). The biceps tendon is heterogeneous in echo texture, with fiber dropouts and an irregular border (in the transverse view). The elbow joint…