A 73-year-old white male presented with a one-day history of a cold, painful, right foot. The foot had a blue discoloration to it, particularly the toes. The emergency physician suspected an atheroembolic cause, given this patient’s age and history of coronary artery disease. However, the patient also reported a one-year history of painful pallor in…
The transition from pediatric to adult care can be a rocky one. For many rheumatology patients, any problems in the move can cause gaps in care. To address this issue, the ACR joined the American College of Physicians’ (ACP) Pediatric to Adult Care Transitions Initiative. The Initiative is a project spearheaded by the ACP’s Council…
This has been a year of tremendous growth, change and achievement for the ACR, and I have been fortunate to lead the ACR in these endeavors. The ACR and ARHP, including the ACR Executive Committee, the ACR Board of Directors, standing and special committee chairs and hundreds of dedicated volunteers, have contributed to this growth…
Which came first? The infectious microorganism or a host’s immune resistance against it? Through the millennia, a raging battle has pitted the hordes of infectious agents surrounding us against, arguably, the most complex biologic structure ever created, the finely tuned human immune system. The stakes are high for both sides. For the infectious agent, an…
Oral health is not frequently considered within the sphere of a rheumatologist’s practice. However, recent results published by the Canadian Scleroderma Research Group (CSRG) point out the importance of assessing oral health in patients with systemic sclerosis (SSc). Result of 3-Year Grant Between 2008 and 2011, 163 patients with SSc and 231 controls were entered…
Depending on stage, severity and rate of progression of disease, systemic corticosteroids are commonly used to treat pulmonary sarcoidosis. However, a review of the literature suggests they have limited usefulness in advanced stage IV pulmonary sarcoidosis. Once sarcoidosis has advanced to this degree, steroid use may unnecessarily expose a patient to life-threatening complications, as demonstrated…
The first month of my last year of rheumatology fellowship began in Addis Ababa, Ethiopia, at Black Lion Hospital, a tertiary university medical center, where I [Dr. Mary Abraham] started an Emory-sponsored global health rotation. Although a very different beginning to my fellowship year, my experiences at Black Lion reminded me of my passion to…
In May, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published its recommendations for the treatment of psoriatic arthritis (PsA).1 The updated recommendations represent advances in drug development and availability since previous recommendations published in 2009, as well changes in treatment paradigms and the importance of associated aspects of the disease.2…
Both due to its efficacy and favorable side effect profile when compared with alternative drugs for rheumatologic conditions, hydroxychloroquine is an important agent in rheumatologists’ armamentarium. However, one barrier to hydroxychloroquine use can be its effects on the eye (also see “Revised Retinopathy Screening Guidelines,”). Ocular side effects of hydroxychloroquine can include impact on the…
A large medical specialty society for ophthalmologists recently updated its recommendations for the screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy.1 The recommendations from the American Academy of Ophthalmology (AAO) affect patients who may use CQ or HCQ for rheumatoid arthritis or systemic lupus erythematosus (SLE), as well as some inflammatory and dermatologic conditions. The…
If you thought the presidential election was a tough choice, imagine selecting this year’s slate of ACR/ARHP award winners. At the 2016 ACR/ARHP Annual Meeting in Washington this November, the ACR and the ARHP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education and patient care. In this issue,…
Rheumatology nurses have a new option to obtain certification. Instead of taking an exam to demonstrate one’s competencies, rheumatology nurses can provide documentation of their expertise through an online application process, the American Nurses Credentialing Center’s (ANCC) Rheumatology Nursing Certification Through Portfolio. Launched in February 2016, the program was developed by the ANCC in collaboration…
A patient presents at her rheumatologist’s office for a visit and is greeted by a certified medical assistant (CMA), who obtains vital signs, gathers health information and updates pertinent information that may have changed since the prior visit. The CMA is one of many healthcare providers who may be involved in the care of rheumatology…
The decision to continue or discontinue immunomodulatory medications during pregnancy is a difficult one for both patients and physicians. On the one hand, when left untreated, rheumatic conditions can cause harm to an unborn child, as well as to the pregnant mother. On the other hand, medications can be harmful to a developing fetus. In…
The State University of New York (SUNY) at Stony Brook was founded in 1957, and is currently known as Stony Brook University. In the 1970s, when the Health Sciences Center was still in the cocoon stages of its metamorphosis, the School of Medicine, under the brilliant stewardship of Marvin Kuschner, MD, was already on a mission…
“Yes sir.” That was the response of Raymond Scalettar, MD, DSc, FACP, when his commanding officer told him the U.S. Army wanted him to switch specialties—from gastroenterology to rheumatology. There was only one problem. Dr. Scalettar wasn’t exactly sure what that would entail. That was the mid-1950s. Back then, rheumatology was barely out of the womb. Residency…
You started a medical practice and, through the years, have developed policies, procedures, strategies, work products, client relationships and confidential information that are specific to your practice and its success. As your practice grows, you know you will need to hire more employees. You also understand, however, that any potential employee may pose a risk…
In 1969, Martha Lovato passed away from renal failure due to complications of lupus. Martha was 18 years old and survived only two years following her diagnosis. At the time, Martha’s disease was still a mystery to many physicians and researchers. Her treatment options were limited. In fall 2004, after an unprecedented battle with shingles…
Although the FDA has not yet awarded the title of interchangeable to any biosimilar, legislation that governs their substitution will continue to be a dominant state issue in 2017. Since 2013, 24 states and Puerto Rico have passed legislation regarding interchangeable biologics. As many as 15 states will have biosimilar-related legislation introduced by coalitions in…
As the year draws to a close, it is vital to pay close attention to your practice’s revenue cycle to maintain an operational and financially healthy business. Operational aspects should be a top priority, with careful monitoring as they relate to efficiency in receivables and denials management. Healthcare revenue cycle management is the strategy that…
A 66-year-old male patient presents to the office with right knee pain. He was in the office two weeks prior for a follow-up visit of his primary osteoarthritis. He received an injection of hyaluronate sodium in his right knee four months before and states that his knee felt like new. He states that everything was…
Take the challenge. CPT: 20611-RT, J1040, 89060 ICD-10: M17.11 Coding Rationale Keep in mind, no evaluation and management services are billed because there wasn’t a separate and/or significant reason, other than the knee injection, addressed during the visit. Note: Although the injection was performed via ultrasound guidance, CPT code 76942 should not be billed with…
For women with antiphospholipid syndrome (APS), treatment with a combination of heparin and aspirin during pregnancy—rather than aspirin alone—may increase live birth rates, according to new research.