Recent updates to criteria used for diagnosing neuromyelitis optica (NMO) are aimed at helping physicians make the differential diagnosis of this disorder differentiating it from other inflammatory disorders—a diagnosis that can be difficult given the presenting symptoms that can mimic a number of other conditions, such as multiple sclerosis. Published in July 2015, the new…
Temporal arteritis was first described by Sir Jonathan Hutchinson in 1890 in an elderly retired gentleman’s servant who developed red, painful streaks on his temples and was found to have bilaterally swollen temporal arteries with feeble pulses.1 Sir Hutchinson disputed the suggestion that the red streaks were caused by the man’s hat and, instead, called…
Case report: A 78-year-old Caucasian female presented to our outpatient rheumatology clinic with pain in her bilateral shoulders, hands and knees that began suddenly one month earlier. She admitted to stiffness in her hands lasting several hours, and expressed an inability to extend her fingers. She denied fever, rashes, jaw claudication, headache or visual changes….
RA vs. Lyme I am writing to comment on your interesting and useful article that appeared on the front page of the August issue of The Rheumatologist, “RA vs. Lyme,” by Charles Radis, DO. Arriving at a definite diagnosis of active RA early on is often not an easy task. The author of this article…
You worked hard your entire life to build your medical practice, and now you’re ready to enjoy retirement. Regardless of whether you choose to sell your practice or gradually wind it down over a period of time, you must take certain legal steps before you can leave. Deciding to Retire & Making a Plan Once…
To practice rheumatology, you’ve got to love a challenge and be prepared to navigate some twists and turns before arriving at the right diagnosis. Rheumatologist and avid kayaker William Truslow, MD, says the same qualities apply to running rivers. “The toughest part is the mental attitude—feeling that I can do this,” says Dr. Truslow, a…
Nancy Baker, ScD, Completes Sabbatical Year at CDC Nancy Baker, ScD, MPH, OTR/L, associate professor in the Department of Occupational Therapy at the University of Pittsburgh, recently completed a yearlong sabbatical as a researcher at the Centers for Disease Control & Prevention (CDC), Division of Population Health. Her mentor at the CDC, Kristina Theis, MPH,…
When deciding where to locate a rheumatology practice, you need to do your homework. There are many factors to ponder, including accessibility, population demographics, competition, need, costs and whether a building meets your needs. First and foremost, it’s important that patients can easily get to and find your practice. Randy Eigen, first vice president, CBRE…
Seven students pursuing rheumatology-related careers will head to San Francisco in November on a Student and Resident ACR/ARHP Annual Meeting Scholarship—awards that are open to students and residents from states that are underserved by rheumatology professionals. The Rheumatology Research Foundation has awarded the students $750–1,500 toward travel expenses and registration for the ACR/ARHP Annual Meeting,…
Gout affects nearly 4% of American adults, causing joint inflammation, pain and crystal deposits that may lead to bone erosion over time. At least five different classification criteria for gout are used worldwide, creating potential discrepancies in clinical trial enrollment and eventual results. An international panel of investigators collaborated to create new, standardized gout classification…
As a physician, you need to focus on your patients’ needs. As someone who owns or manages a rheumatology practice, you need to focus on your business’s needs. “This can feel like you’re not only wearing two different hats, but that you also have to be two different people,” says Virginia Fraser, global content specialist,…
One month has passed since the U.S. healthcare system overcame a historical milestone with the conversion from billing ICD-9-CM to ICD-10-CM. Although the transition to ICD-10 had a major impact on coding operations, its far-reaching tentacles go beyond coding alone and are deeply rooted in the entire revenue cycle. There is room to criticize the…
CPT: 99213, 73500-RT, 73500-LT ICD-10: M16.52 This E/M service entailed: The history is detailed; The examination is expanded problem focused; and The medical decision making is of low complexity. The X-ray reviewed was for radiologic examination, hip, unilateral: one view for the left hip and for the right hip. M16.52—The diagnosis identifies unilateral post-traumatic osteoarthritis…
Post-Traumatic OA A 70-year-old female patient comes in for a follow-up visit for pain and stiffness in her left hip. She injured her hip in a skiing accident three years before and reports the X-rays at that time showed no fractures. Due to no obvious fracture at the time, she was given ibuprofen and advised…
Accepted Annual Meeting abstracts are now available online. Search abstract presentations online or download a PDF of the online 2015 ACR/ARHP Annual Meeting Abstract Supplement. Our online resources center is your single point of access to Annual Meeting program information. View, print or download Annual Meeting publications or access the app.
“Do you seriously want me to stand on my tiptoes?” my gruff 68-year-old patient at the VA Rheumatology Clinic asked, incredulous. “I came with a walker. I think you very well know, doc, that if I get on my tippy-toes, then I’m going to fall flat on my face.” He had a point, one that…
As the Association of Rheumatology Health Professionals (ARHP) continues to celebrate its 50th anniversary, The Rheumatologist recently spent time with Charter Member and Past President Marlin N. Shields, RPT, discussing the history of the ARHP and the changes he has seen in rheumatology. One topic that was, and remains, near and dear to him is…
For the past 30 years, the Rheumatology Research Foundation has been an invaluable resource for investigators looking to further their careers and expand essential research into rheumatic diseases. Among the Foundation’s many award recipients is Robert Plenge, MD, PhD. In 2008, Dr. Plenge received a grant from the Foundation to pursue finding a genetic basis…
As a practicing rheumatologist, I have experienced the increasing payer and government involvement shaping our evolving healthcare system. New payment models, changes in health insurance coverage, the federal mandate for the adoption of electronic health records and the implementation of ICD-10 are recent changes that have rocked our world. Our patients are also paying the…
Despite a generation of advances in molecular biology, a huge gap exists between the Sjögren’s syndrome (SS) patient’s description of their symptoms and the objective findings. Current issues include: Many SS patients are misclassified as either rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), even within rheumatology clinics. Frequently, the sickest SS patients with extraglandular…
I sometimes find myself mired in sticky clinical circumstances. I am facing a distraught patient who is seeking my opinion about a condition that, according to some, may not truly belong in the rheumatologist’s bailiwick. Case example: hearing loss. The Steroid Test Sudden sensorineural hearing loss (SSNHL) and its relative, autoimmune inner ear disease (AIED),…
Brentuximab Vedotin Enters Phase 2 Trials Brentuximab vedotin (Adcetris), an antibody-drug conjugate (ADC) directed at CD30, is currently entering Phase 2 clinical trials for treating systemic lupus erythematosus (SLE).1 The ADC encompasses an anti-CD30 monoclonal antibody, which is attached by a protease-cleavable linker to a microtubule-disrupting agent, known as monomethyl auristatin E (MMAE). The ADC…
In the late 1990s, Thomas Baranowski, PhD, professor of pediatrics specializing in nutrition at the Baylor College of Medicine, Houston, applied for a grant. For years, he had been interested in finding ways to get children to change their diet and physical activity. He decided to try a video game, and he got the money…
Background Autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematous, occur when the body attacks its own tissue because it cannot differentiate between self and non-self. This is mainly through deregulation of the immune system. Vitamin D has been known to play a critical role in bone mineralization and bone health. Activated vitamin…
Case report: A 60-year-old Hispanic male with poorly controlled hypertension was sent from the primary care clinic for evaluation of malignant hypertension with a systolic blood pressure above 200 mmHg. His symptoms at the time of presentation included episodic confusion, worsening vision and an unsteady gait. A head computed tomography (CT) scan showed a subacute…
I am a few weeks post-retirement. Having written thank you notes and completed urgent home projects, I swing in a hammock at our currently fire-threatened cabin north of Winthrop, Wash., and reflect. I feel like a young boy while freely flipping pages of a hand-scribed picture book, The Principles of Uncertainty, by Maira Kalman. She…