Where can patients obtain more information about their diagnoses and prescription drugs, and answers to the assortment of questions they have about living with a chronic disease once they leave the rheumatologist office? Patient education materials can be found in many places on the internet, but those looking for answers may need a helping hand…
Table stakes. It took me a moment to register what they were talking about. I was listening to Pod Save America, a wildly popular podcast put together by some of Barack Obama’s former speechwriters. It is, I imagine, what an MSNBC podcast might sound like if Rachel Maddow and Chris Hayes were allowed to swear….
Sometimes it’s hard to get a song out of your head, especially when you can’t recall all the lyrics and struggle to find the words to fill in the blanks. That’s what happened to me when I started to write this column. A song, probably too dated now for many to find particularly compelling, kept…
The College’s principal journals have been telling the tale of workforce woe, exploring the reasons for our predicament and potential solutions for the long and short term.1,2 Among the medium-term remedies is increased use of advanced practice clinicians (APCs), as we collectively refer to nurse practitioners and physician assistants in rheumatology practices. Solutions Estimates of…
Over the past few years, biosimilars and other new drugs have been introduced to treat rheumatic illnesses. Some of the conditions we treat have numerous drug option; others have few or only off-label options. This series, “Rheumatology Drugs at a Glance,” provides streamlined information on the administration of biologic, biosimilar and other medications used to…
Stroke and transient ischemia are the most common cerebrovascular events in lupus patients, and a new study has found most of these occurrences can be attributed to lupus itself rather than other causes. The study, published in the October 2018 issue of Arthritis Care & Research, looked at the frequency, association and outcomes of cerebrovascular…
NEW YORK (Reuters Health)—In patients with psoriasis and psoriatic arthritis, the incidence of atrial fibrillation and major adverse cardiovascular events does not differ between treatment with ustekinumab and TNF inhibitors, according to a large observational study. “Given a high cardiovascular risk among patients with psoriasis and psoriatic arthritis,” Seoyoung C. Kim, MD, ScD, MSCE, told…
Postmenopausal women are often told to consume more than 1,500 mg of calcium daily to reach neutral bone balance. But new research suggests this recommendation should be revised, finding no connection between dietary calcium intake and postmenopausal bone loss…
Presentation A 30-year-old woman presented to her rheumatologist for left foot pain of three weeks’ duration. She was followed for systemic lupus erythematosus manifesting in arthritis and hemolytic anemia, as well as anti-nuclear antibody and Smith antibody positivity, and was treated with hydroxychloroquine and prednisone in the 2.5–10 mg per day range. She was symptom…
Psoriatic arthritis came to be viewed as a distinct disease entity with specific clinical features, genetics and pathophysiology only gradually. One important historic development in this transition was a 1973 paper written by a pair of researchers out of Leeds, England: John M. Moll, BSc, DM, and Verna Wright, MD, FRCP.1 Here we discuss the…
Involving pharmacists in the management of chronic diseases benefits patients, says Wendy Ramey, BSPharm, RPh, CSP, a clinical pharmacy specialist in rheumatology at the University of Kentucky, Lexington. She knows this personally. As someone with rheumatoid arthritis (RA), Ms. Ramey knows pharmacists can play an important role in patient education and encouraging adherence to medications….
Eosinophilic fasciitis generally presents with the acute onset of edema followed by progressive skin induration in the setting of hypergammaglobulinemia, an elevated erythrocyte sedimentation rate (ESR) and peripheral eosinophilia in 63–93% of patients.1,2 Skin involvement is typically limited to 20.1% of total body surface area and most commonly involves the extremities symmetrically.1,3 The condition was…
What happens when systemic sclerosis (SSc) overlaps with other systemic autoimmune rheumatic diseases? Patients with either diffuse cutaneous or limited cutaneous SSc sometimes develop systemic lupus erythematosus (SLE) as well. A new, large cohort study published in the Journal of Rheumatology reveals details on the epidemiology, clinical signs and survival data of SSc-SLE overlap syndrome.1…
A new study from Johns Hopkins University School of Medicine, published in the September 2018 issue of Arthritis Care & Research, identifies risk factors and clinical features associated with severe gastrointestinal (GI) dysmotility in patients with systemic sclerosis.1 The findings suggest a distinct pathological process may be at work in this patient group, says lead…
Dominick Sudano, MD, an assistant professor at the University of Arizona and rheumatologist at Banner University Medical Center, Tucson, Ariz., knows how tough it is for patients living in remote areas to obtain a rheumatology consultation. “It’s not unusual for patients living in rural areas of Arizona to wait four to six months for a…
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 our Lessons from Master Clinicians series for The Rheumatologist, we present insights from clinicians who have achieved distinction in the field of rheumatology and who are…
“Hi, I’m Dr. Kumar, and I’m an allergist,” is something I sometimes fumble when I introduce myself to confused rheumatology patients, before I quickly correct myself with, “… well, I’m also a rheumatologist.” There’s a moment of slight embarrassment that I crossed my circuits, but otherwise I’m proud to say I’m certified in both. This…
At least 6% of patients who used biologic disease-modifying anti-rheumatic drugs (bDMARDs) suffered refractory disease, according to a recent study based on data from the British Society for Rheumatology Biologics Registry for Rheumatoid Arthritis.1 This observational study evaluated the extent of biologic refractory rheumatoid arthritis (RA). The study defined biologic refractory disease as occurring in…
In the past decade, the treat-to-target concept has gained broad acceptance. Both the ACR and European League Against Rheumatism (EULAR) management recommendations include adding biologic therapies to the treatment regimen for rheumatoid arthritis (RA) patients who do not sufficiently respond to methotrexate monotherapy. “What EULAR says is that if [methotrexate use fails], you should essentially…
A recent proof-of-concept study to evaluate nuclear imaging in interstitial lung disease (ILD) concludes it is feasible to study ILD subtypes using this technology to visualize specific molecular processes of ILD. The process has important potential applications for the development of targeted molecular therapies.1 ILD is an umbrella term for a group of heterogeneous lung…
Dry eye affects at least 30 million people in the U.S. and many more around the globe. Among patients with autoimmune disease—including Sjögren’s syndrome and rheumatoid arthritis—that number can climb even higher. Although dry eye may sound like just an annoyance, it can range from mildly irritating to debilitating, depending on the extent of the…
Imagine leaving the hospital after suffering a heart attack without being treated for hypertension or being started on a beta blocker. What would we think of the hospital where patients are never educated about the relationship between treating hypertension and reducing myocardial infarction and stroke risk? Unfortunately, this happens every day with osteoporosis and fractures…
A Milwaukee rheumatologist delivered lectures, participated in Grand Rounds and consulted on rheumatology treatment strategies during his visit this winter to the Patan Academy of Health Sciences (PAHS), Nepal. Paul Halverson, MD, affiliated with Froedtert Hospital and the Medical College of Wisconsin, says the several days he spent in Patan, Nepal, adjacent to Kathmandu and…
A post-hoc analysis of data from two large clinical trials supports treat-to-target recommendations for patients with rheumatoid arthritis. The research found baseline disease activity was the strongest predictor of a patient’s insufficient response to initial therapy at six months…
CHICAGO—The ingredients required to make a rheumatologist have changed from the early years of the last century to now and are moving toward further transformation in the millennial-influenced future, according to Calvin Brown, MD, keynote speaker at the ACR’s 2019 Program Directors Conference. Dr. Brown, who trains medical students at Northwestern University Feinberg School of…
SNOWMASS VILLAGE, COLO.—Even in the era of treat to target, cardiovascular disease risk remains elevated and is a major source of mortality and morbidity in patients with rheumatoid arthritis (RA). Screening and management of cardiovascular risk in these patients is critical to ensure these patients are identified and treated. At the 2019 ACR Winter Rheumatology…
SNOWMASS VILLAGE, COLO.—The 2019 ACR Winter Rheumatology Symposium featured a session on gout. Despite a good understanding of its pathogenesis and the many effective therapies to treat it, gout remains a major public health problem in the U.S. Ann K. Rosenthal, MD, Will and Cava Ross professor of medicine and chief of the Division of…
SNOWMASS VILLAGE, COLO.—Data from three recent trials in systemic sclerosis (scleroderma) provide information on a number of important issues related to screening and treatment. First presented at the 2018 ACR/ARHP Annual Meeting, the phase 2/3 trials assessed the safety and efficacy of targeted agents to treat patients with systemic sclerosis.1-3 In a follow-up presentation at…
Paul Sufka Named Social Media Editor for New ACR Twitter Account A clinical rheumatologist with HealthPartners in St. Paul, Minn., Paul Sufka, MD, is conversant with social media: he’s been on Twitter for almost 10 years; has hosted an online rheumatology podcast; and blogs about physician self-care and using Twitter as a tool at medical…
You are a new practitioner, ready to begin your first job, one for which you’ve been preparing for years. Your prospective employer gives you an agreement that outlines your compensation, scope of work, requirements and benefits. You are eager to start your new assignment, and you want to sign this document quickly to make your…
Farokh Jamalyaria, MD, a rheumatologist in Houston, never set out to become a birder. He remembers his first foray into birding as being completely unintentional. At 8 years old, while living in Ruston, La., he showed his mother an image of an ivory-billed woodpecker—an extinct species last spotted in the 1940s about 100 miles from…
Japan has approved risankizumab for treating plaque psoriasis, generalized pustular psoriasis, erythrodermic psoriasis and psoriatic arthritis in adults…
Health Canada has approved adalimumab for treating chronic non-infectious anterior uveitis in patients 2 years and older…
The Accelerating Medicines Partnership (AMP) was launched in 2014 as a public-private partnership to spur development of new therapeutic options for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Five years in, this unprecedented public-private effort is achieving its major milestones and yielding tools to accelerate potential new drug discoveries. The Rheumatology Research Foundation is…
Analysis of the 2015 ACR Workforce Study, published in the April 2018 issue of Arthritis Care & Research, revealed the U.S. will face a shortage of 4,000 rheumatology providers by 2030.1 This shortage will be uneven, with rheumatology providers concentrated in urban and suburban areas, and rural areas underserved. The Central U.S., Southwest, Southeast and…
The world we live in necessitates information be communicated in a quick and easy manner. This remains true in the healthcare setting. The ability to text or email staff and patients has become a priority for many healthcare entities. However, maintaining patient privacy and confidentiality is essential to ensure we meet compliance standards. Although emailing…
Scenario A A 67-year-old, female Medicare patient diagnosed with rheumatoid arthritis, previously without rheumatoid factor, calls the rheumatologist’s office to get an update on the lab tests taken when she was last seen in the office two weeks before. The patient was tested for C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and…
Take the challenge. Scenario B is billable and should be coded as G2012. The ICD-10 is M06.09. As of January 2019, the Centers for Medicare & Medicaid Services has allowed a new code to be billed for a brief communication for virtual check-in by a physician or a qualified healthcare professional who can provide an…