As questions about biosimilar medications swirl among U.S. rheumatologists, a recently released report sheds some light on the European experience with biosimilars—and may offer some important insights for the U.S. market. The report, Biosimilars in the EU: Information Guide for Healthcare Professionals, was released in late April by the European Medicines Agency (EMA) and the…
Systemic sclerosis (SSc), a subtype of scleroderma, is a rare, complex autoimmune disease characterized by widespread vasculopathy of the small arteries and fibroblast dysfunction.1,2 It has been described as a fibrosing microvascular disease, because vascular injury precedes and leads to tissue fibrosis.3 The resulting Raynaud’s phenomenon, pain, skin thickening and tightening, and multi-organ involvement have…
An Unforgettable Story Her name was unforgettable. Not only did we share our given names—Simon and Simone, but her French-Canadian surname was based on this appellation, too. I was the junior resident working on our hospital’s nephrology service when she was admitted for evaluation of progressively worsening kidney disease and an overall failure to thrive….
The Rheumatology Research Foundation and the ACR are committed to advancing the future of rheumatology to support patients living with rheumatic diseases. These organizations are focused on addressing one of the most critical issues facing patients and rheumatology today—the growing shortage of rheumatology professionals. The ACR’s 2015 Workforce Study revealed the dire need for support…
Interest in viewing the nail capillaries dates to the late 17th century. Later research by Maurice Raynaud and others in the late 19th and early 20th century first established a direct link between the nailfold capillaries and certain medical conditions. Although underutilized in the past, with the advent of modern digital equipment and the validation…
A stroll through downtown Stockholm presents a quintessential picture of an active community, with most people biking or walking as their preferred mode of travel. Yet children in Sweden who live with juvenile idiopathic arthritis (JIA)—currently estimated at around 64 of every 100,000—don’t always engage in this active lifestyle.1 Maura Daly Iversen, PT, DPT, SD,…
After having had juvenile idiopathic arthritis (JIA) for 20 years, I had a moment in my journey when I realized something new: “Your arthritis doesn’t just affect you, you know,” my sister said. This statement stopped me in my achy tracks. For two decades, I had been operating under the assumption that JIA was my…
CHICAGO—“Why do so many drugs fail in clinical trials?” asked Michael Brenner, MD, chief of rheumatology, immunology and allergy at Brigham and Women’s Hospital in Boston. This question, previously posed by Francis Collins, MD, PhD, director of the National Institutes of Health, prompted a discussion among scientists and stakeholders in the pharmaceutical industry. The conversation…
CHICAGO—Joseph Breen, PhD, program officer at the National Institutes of Health in Bethesda, Md., opened the chronic fatigue syndrome (CFS) session at the Federation of Clinical Immunology Societies (FOCIS) 2017 meeting by asking presenters to describe the current state of the science to the key immunology stakeholders gathered in the room. The hope was that…
CHICAGO—During the 2017 annual Federation of Clinical Immunology Societies (FOCIS) meeting, a session focused on precision immunology and its advances. Precision immunology describes the identification of host, immune system and tumor factors that can be used to select an immunotherapy approach. Thus, the first step in precision immunology is to identify soluble factors, immune cell…
Limited data exist on the clinical presentation of Muckle–Wells syndrome (MWS) during pregnancy. The purpose of this case report is to highlight the diagnosis of MWS in a pregnant woman. Many rheumatic diseases affect women of childbearing age, and their management during pregnancy can be challenging. Case A 33-year-old, 18-weeks’ pregnant woman was hospitalized for…
MADRID—Research into pharmacodynamic biomarkers has shown that macrophages may have an important role in the pathogenesis of several diseases, including systemic sclerosis, an expert said at the 2017 Annual European Congress on Rheumatology (EULAR). The findings were discussed in a session that also covered how an understanding of M1 macrophages’ role in fibrosis has evolved…
MADRID—Researchers have found that systemic lupus erythematosus (SLE) is independently linked with bipolar disorder and say the findings point to a need for greater awareness of psychiatric problems in patients with SLE. In work led by investigators at Tel Aviv University in Israel and presented at the 2017 Annual European Congress on Rheumatology (EULAR), researchers…
MADRID—Systemic lupus erythematosus (SLE) experts in North America and Europe are working together to refine the classification system for the disease, with the goal of producing a new set of criteria that is simpler to use and more scientifically rigorous than any classification approach previously published, speakers involved with the process said at the 2017…
Efficiently meeting the needs of people with rheumatic disease requires the expertise of a team of health professionals. During their formal education, health professionals acquire the knowledge, skills and attitudes that prepare them to best contribute to a healthcare team. Maintaining and expanding that knowledge happens during continuing education and post-graduate programs, which ensure lifelong…
To correctly address a problem, one must have a handle on its nuances—a clear understanding of what is linked and how. And thus far, when it comes to lupus, we haven’t reached the point of understanding those intricacies. Things are heading in the right direction, however, with two new studies that get us much closer…
A 51-year-old Caucasian female was referred by a local rheumatologist to the Center of Autoinflammatory Diseases at Stony Brook University, N.Y., for an unusual disease presentation. The patient had had recurrent polyarthritis, fever and rash for the previous three years. She described having a migratory polyarthritis affecting the shoulders, knees, ankles and bilateral forefoot, with…
In a world where some information is good, more information is better and information overload is a way of life, Carole Dodge, BS, OTR, CHT—a practicing occupational therapist at the University of Michigan—considers the ARHP her professional block and tackle. “ARHP helps me sift through a lot of information and get it to a digestible…
Editor’s note: The new Pillar Talk column is developed by the ARHP Executive Committee in an effort to share information about ongoing activities related to our four pillars: Education, Practice, Research and Advocacy. The ARHP Research Subcommittee is committed to promoting research and enhancing research opportunities for health professionals and researchers working in rheumatology. A…
Case Ms. A is an 82-year-old woman who presented to the rheumatology office for evaluation of osteoporosis. She had been diagnosed with postmenopausal osteoporosis at age 62 after sustaining a right wrist fracture. She was started on alendronate 70 mg weekly and reported medication compliance. At age 79, she sustained an atraumatic right femur fracture….
The ACR Rheumatology Research Workshop (RRW) is a two-day meeting designed to promote interactions between early and established investigators to foster collaboration and facilitate career mentoring. The RRW is targeted to rheumatology fellows, junior faculty, medical/graduate students, and residents interested in learning more about how to succeed in a research career for rheumatology. RRW is…
Connect with colleagues at the Basic Research Conference (BRC) and the Clinical Research Conference (CRC) pre-meeting courses at the 2017 ACR/ARHP Annual Meeting! The ACR has an exceptional array of research leaders lined up for this year’s BRC and CRC courses on Friday, Nov. 3, and Saturday, Nov. 4, in San Diego. Get ready to…
The ACR Early Career Investigators (ECI) Subcommittee has organized two sessions at the 2017 ACR/ARHP Annual Meeting in San Diego. These sessions are devoted to serving the needs of early career investigators including junior faculty, fellows, graduate students and post-docs. Both sessions provide unique opportunities to optimize the research landscape for early career investigators. Mentoring…
ACR advocates recently returned to Capitol Hill to meet with members of Congress as part of the Advocates for Arthritis fly-in conference on Sept. 26. This annual event brings together rheumatology professionals to advocate on behalf of the rheumatology community. Core issues on which the advocates focused this year include lowering the out-of-pocket cost of…
Physicians are increasingly fighting multiple forces in running a practice, and one of the most common barriers to effective revenue cycle management is frequent medical billing and claim denials. An insurance company’s denial for services places a significant strain on the financial process of the practice, which affects the bottom line. According to the Medical…
‘Living’ Pelvis in the Guinness Book of World Records Shashank Akerkar, MD, an ACR fellow and rheumatoid arthritis specialist at the Mumbai Arthritis Clinic and Research Center in India, found a unique way to draw attention to ankylosing spondylitis (AS). He persuaded 425 patients, mostly those suffering from AS or affected by lupus or rheumatoid…
Osteoporosis Screening The aphorism, “Those who do not learn history are doomed to repeat it,” applies to The Rheumatologist August 2017 article that documents the continued low screening rates for those at high risk for osteoporosis-related fragility fractures, in particular people older than 65 and those who have suffered a fracture already. So here’s a…
Deborah Dyett Desir, MD, vividly remembers her first day as an undergraduate student at Harvard University, Boston. When her parents helped her move into the dorm, her mother, Betty, handed her a beautiful begonia. “My response was, ‘What on earth am I going to do with this plant?’” she says, recalling how she examined the…
FDA Approves Adalimumab-adbm On Aug. 29, the FDA approved Cyltezo (adalimumab-adbm), a biosimilar to Humira (adalimumab).1 Cyltezo was approved as a prefilled syringe to treat multiple chronic inflammatory diseases, including moderate to severe active RA, active psoriatic arthritis and ankylosing spondylitis, and moderate to severe plaque psoriasis. The treatment has also been approved for moderate…
An established, 66-year-old male patient is seen in the office for a follow-up visit for his fibromyalgia. The physician makes the decision to prescribe venlafaxine for anxiety and depression, and gabapentin for nerve pain. After the visit, the physician informs his medical assistant (MA) to contact the patient’s insurance carrier because venlafaxine requires a prior…
Take the challenge. CPT codes 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour 99359—each additional 30 minutes (list separately in addition to codes for prolonged service) Coding Rationale No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting…
While the latest version of the Republican-sponsored healthcare bill once again falters and its prospects of becoming the new law of the land fade, plenty of advocacy work is continuing on behalf of rheumatologists and rheumatology practices. The ACR, along with multiple partners, has renewed its push for regulatory relief in a number of areas…
In many respects, this is the beginning of the golden age of rheumatology. Diagnostic and therapeutic approaches are now available that have radically altered for the better the lives of people with diseases that were considered virtually untreatable just a few years ago. The rheumatologist’s approach to patients with rheumatoid arthritis, the spondyloarthropathies, osteoporosis and…