If someone had told me that one day I would serve as the 82nd president of the ACR, I would have thought it as likely as lassoing the moon. Now, with the gavel passed to me at our 2018 Annual Meeting, I assume this role in awe of the enormity of this honor, as well…
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and morning stiffness at the neck, shoulders and hip girdle. It can be associated with giant cell arteritis (GCA); in fact, the two disorders may represent a continuum of the same disease process. This case describes a patient who initially refused treatment for PMR…
Black powder was initially developed in 9th century China, by Taoists searching for the philosopher’s stone, which fans of Harry Potter will remember is the talisman that grants eternal life. The Chinese name for black powder literally translates as fire medicine. The chemical composition of black powder was first recorded in China during the 11th…
The past 20 years have seen dramatic changes in the practice of rheumatology, ranging from bench to bedside therapeutic advances to dramatic improvements in diagnostic imaging. The results have been gratifying for our patients and attractive to internal medicine trainees making subspecialty career decisions. We are pleased to provide this article for The Rheumatologist’s wide-ranging…
Missed appointments have long been a problem for rheumatology practices. A recent poll from the Medical Group Management Association (MGMA) found no-shows were the single biggest challenge reported by practice leaders, with 44% of respondents citing the issue.1 If a patient does not come to the office when scheduled, it starts a cascade of events…
During a recent divisional grand rounds presentation, I asked a room full of my colleagues how many of them had been asked about turmeric by a patient within the past year, month, week or day. Most hands remained up by the end of the exercise. During a recent trip to New York City, I was…
CHICAGO—At the 2018 ACR/ARHP Annual Meeting in October, the ACR and the ARHP honored distinguished individuals who have made significant contributions to rheumatology research, education and patient care. This month, The Rheumatologist speaks with the ACR winners about their individual contributions to advancing rheumatology. You’ll also find the 2018 Masters list. In the next issue,…
Presentation A 26-year-old man with a history of acne vulgaris and hidradenitis suppurativa presented to our rheumatology clinic with persistent back pain and stiffness of three years’ duration. He described bilateral low back pain that was worse when he arose in the morning and at night when he was trying to sleep. In a similar…
NEW YORK (Reuters Health)—A large epidemiological study provides more evidence of a link between tumor necrosis factor inhibitors (TNFi) and peripheral neuropathy (PN). “These events are rare and the benefit of these drugs still outweigh this risk so this should not change practice,” cautions first author Dr. Mahyar Etminan from the University of British Columbia…
Researchers say a study of individual antibody response to citrullinated and non-citrullinated proteins in sputum samples further supports the importance of the lung in early development of rheumatoid arthritis-related autoimmunity. Investigation of the fundamental mechanism that leads to antibody responses in rheumatoid arthritis is key to uncovering ways to predict and prevent the development of…
“Don’t believe everything you think,” said Allan Lokos, the founder and guiding teacher of the Community Meditation Center located in New York City’s upper west side. These words may be especially important for those dealing with chronic pain, finds new multicenter research. The study, “Trajectories of Fear-Avoidance Beliefs on Physical Activity Over Two Years in…
The ACR will add a new professional journal, ACR Open Rheumatology, in January 2019. An open access journal, it will feature the same high-quality, rigorously peer-reviewed articles on original investigations in rheumatology research, as well as commentaries and reviews, as the ACR’s other journals, Arthritis & Rheumatology (A&R) and Arthritis Care & Research (AC&R). Co-Editors-in-Chief…
Psoriatic arthritis (PsA), like other inflammatory diseases, has been associated with increased incidence for and mortality from cardiovascular disease (CVD), the most common comorbidity leading to death in many conditions treated by rheumatologists. But beyond recognizing the burden of increased inflammation, the mechanisms behind this association are not well understood, says M. Elaine Husni, MD,…
Recent data showing sustained, long-term safety and efficacy of mavrilimumab for the treatment of rheumatoid arthritis (RA) confirm and build on prior evidence from phase 2 studies of the potential for this new agent for the treatment of RA. Mavrilimumab is a human monoclonal antibody that blocks a proinflammatory cytokine involved in RA pathogenesis—granulocyte-macrophage colony-stimulating…
Indigenous communities in Latin America lack good healthcare—and often lack any healthcare—for musculoskeletal and rheumatic diseases.1 Global health initiatives tend to focus on infectious disease, despite the increasing rate of chronic diseases. In a survey of 6,155 individuals from eight indigenous communities, conducted by a team of Latin American investigators, the prevalence of these conditions…
A study published in the May issue of Arthritis Care & Research may be the first to examine the long-term outcomes of childhood-onset lupus, otherwise known as pediatric systemic lupus erythematosus (SLE), a chronic, multisystem autoimmune disease with a highly variable clinical course. Previous studies examined cross-sectional views of damage accrued. According to the Childhood…
The incidence of lupus nephritis in patients with systemic lupus erythematosus (SLE) has decreased over the past 50 years, according to a study from Gabriella Moroni, who works in the Nephrology Unit at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milano, Italy.1 Typically, renal involvement is part of the disease course for two-thirds of…
A recent study suggests costly antibody screening among patients with systemic lupus erythematosus could be reduced by limiting repeat screening of extractable nuclear antigens (ENAs). Researchers investigated how often results changed for anti-ENA and other commonly screened antibodies in repeat testing of patients with SLE. The findings were published in the Journal of Rheumatology.1 “We theorized,…
Knee osteoarthritis (OA) accounts for more than 80% of OA disease burden and has doubled in prevalence in the mid-20th century in the U.S. when compared with people who lived during early industrial era (1800s to early 1900s).1 Currently, the diagnostic and treatment armamentaria are limited. Disease progression is measured by joint space narrowing on…
In summer 2017, I was a few months post-partum when I received an email announcing applications for the ACR’s Advocacy 101 program. It would take only a few days, but I asked my division director if it would be worth the time commitment. He questioned the career benefits of advocacy, but encouraged me to apply…
Mart Mannik, MD, professor emeritus, Division of Rheumatology at the University of Washington (UW), passed away on Wednesday, Aug. 22, 2018. Dr. Mannik was born in Estonia and came to the U.S. at age 12 as a refugee from World War II. He received his medical degree from Western Reserve University School of Medicine in…
Researchers working to decode the epigenetic landscape for rheumatoid arthritis (RA) were surprised to discover a connection to Huntington’s disease, a finding that could pave the way to discoveries of new therapeutic targets. By developing new methods to integrate data from epigenetic technologies, scientists at the University of California, San Diego (UCSD), set out to…
Donah Zack Crawford, MA, was a research coordinator at the University of Pennsylvania, focused on premenstrual syndrome and perimenopause, when her symptoms first started. “Someone suggested I see a rheumatologist,” she says, and not long after, Philadelphia-based physician Bruce Hoffman, MD, diagnosed her with rheumatoid arthritis. It was the mid-1990s, and treatment options were limited….
People with autoimmune connective tissue diseases produce antibodies against nuclear antigens up to 10 years before they develop clinical features. Anti-nuclear antibodies (ANAs) are also very common, and a small percentage of ANA-positive patients progress to clinical autoimmunity. The question: Is there a reliable way to screen at-risk patients before they develop active autoimmunity and…
Traditional X-rays, move over—there may be a new gold standard for joint imaging to assess even the smallest changes that can signal the onset of arthritis, as reported recently in the journal Scientific Reports.1 Utilizing the combined expertise of radiologists, rheumatologists and engineers, University of Cambridge researchers developed an algorithm to monitor the joints of…
BALTIMORE—Understanding issues regarding pregnancy in women with rheumatic disease is important to patients and physicians alike, said Bonnie Bermas, MD, the Dr. Morris Ziff Distinguished Professor in Rheumatology at UT Southwestern Medical Center, Dallas, in her recent lecture at the Maryland Society for the Rheumatic Diseases.The physiologic changes in normal pregnancy, which include increased circulating…
Higher anxiety levels in postmenopausal women may put them at increased risk of fracture and should be considered when assessing a woman’s risk of osteoporosis as well. This is the conclusion of a study recently published in the journal Menopause that looked at the role of anxiety in bone health.1 Specifically, the study examined the…
Recent studies point to a relationship between scleroderma and autoantibodies (e.g., anti-RNA polymerase III or anti-RNPC3), and an increased cancer risk within a short interval of scleroderma onset. Mechanistic studies provide further evidence that cancer may trigger scleroderma in patients with these autoantibodies. However, many questions remain unanswered. A study in the Annals of the…
Currently, treatment options for patients with peripheral spondyloarthritis, which includes psoriatic arthritis and non-psoriatic types, are limited. Philippe Carron, MD, Department of Rheumatology, Ghent University Hospital, Belgium, says, “One of the problems we encounter in the daily management of peripheral spondyloarthritis is that we have no other therapeutic options in patients refractory to NSAIDs [non-steroidal…
Scleroderma Foundation Names Doctor of the Year The Scleroderma Foundation has named Lesley Ann Saketkoo, MD, MPH, doctor of the year for her leadership and commitment to the scleroderma community. Dr. Saketkoo is an associate professor of clinical medicine at Tulane University School of Medicine, New Orleans. Dr. Saketkoo is an internationally recognized researcher, educator…
Years ago, 16-year-old Bryce Binstadt, now a pediatric rheumatologist at the University of Minnesota Masonic Children’s Hospital, was waterskiing with friends on Potato Lake in Minnesota, where his family frequently vacationed. Dr. Binstadt had been an avid water-skier since he was 8 years old and had become very skilled at the sport—even skiing backward. This…
The FDA has expanded the new Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) to include immediate release opioids. The program, which also includes extended release and long acting opioids, will provide education to prescribers and healthcare professionals…
After meeting with the FDA, the makers of intravenous meloxicam plan to resubmit the treatment’s new drug application…
The Rheumatology Research Foundation has embarked on its third and most ambitious fundraising campaign, with a goal of raising $75 million. The Leading Boldly: Transforming Rheumatology campaign will support Foundation programs to recruit the best and brightest into the field, train rheumatology health professionals at all career stages and support investigators conducting research that will…
All 2018 ACR/ARHP Annual Meeting attendees received a complimentary, one-year ACR Beyond Streaming subscription. Recipients have access to all of the recorded sessions from the Annual Meeting, as well as more than 500 sessions from past meetings. In addition, they have the opportunity to view recorded sessions from upcoming 2019 educational meetings, including the Winter…
Improving access to rheumatology care for underserved patient populations is a priority for the ACR, and the subject of a major position statement by the Committee on Rheumatologic Care (CORC) in 2017. According to the ACR’s 2015 Workforce Study, the existing shortage of rheumatologists and rheumatology health professionals is expected to worsen in the next…
A 70–year-old female patient with rheumatoid arthritis affecting multiple joints who is rheumatoid-factor positive but without organ or system failure returns for her third infliximab infusion. She is scheduled to receive 500 mg of the drug. How should this encounter be coded? 96413, 96415, J1745 x 50; ICD 10: M05.79 96413, 96415, J1745 x 50;…
Take the challenge. C—This claim cannot be coded without querying the infusion nurse and physician. There must be documentation of the patient’s weight to document the correct dosage of the medication to be given to the patient. Also the start time and the completion time of the infusion must be documented to know which drug…
Throughout a patient’s lifetime, providers are entrusted with their most intimate and personal information, which they expect to be kept private and confidential. Unfortunately, the healthcare system can face serious implications if any part of a patient’s privacy or information is breached. Under the Health Information Portability & Accountability Act (HIPAA) and state laws healthcare…
In a rheumatology practice, registered nurses take on multiple roles, from administrative tasks to engaging in patient support and assessment. They can aid rheumatologists and help provide the best care to patients…
Previous research has established that gout and hearing loss have shared risk factors. Now, a recent study found gout itself is associated with an increased risk of hearing loss in adults 65 years and older…
(Reuters Health)—Online socializing may weaken the tie between pain and depression for older people, a U.S. study suggests. People in chronic pain are at risk of depression to start with. When pain makes them stay home more, interacting with friends and family less, it only adds to this risk, the researchers write in the Journals…
NEW YORK (Reuters Health)—Allopurinol does not appear to contribute to decline in kidney function and may actually protect renal function in patients with gout, according to a large population-based study. Gout affects around 4% of Americans and often occurs alongside chronic kidney disease (CKD), Dr. Tuhina Neogi from Boston University School of Medicine and colleagues…