I glanced up from Amanda Wolf’s chart as the emergency department nurse, followed by the lab technician (tech), followed by the electrocardiogram (ECG) tech flowed into cubicle No. 5. John Benner, MD, pulled up a chair to review the case with me at the nursing station. “Here’s what we’ve got. Thirteen-year-old girl with a one-week…
“Men work harder than women.” My mother is a pediatrician, and I have two sisters—one is a dermatologist, and one is a real estate attorney. Therefore, I think understandably, this message took me by surprise. Of late, I have been particularly awed by my lawyer-sister, with whom I catch up when she is taking the…
In our fast-paced world, a great deal can happen in 12 months. Reflecting on this past year and my service as ACR president, I find this has certainly been the case. For the foreseeable future, it appears the factors that influence our ability to effectively care for our patients with rheumatic and musculoskeletal disease will…
I attended medical school in the 1960s, when Dr. Lawrence Weed reinvented the medical record to organize and leverage the physician’s patient evaluation for clarity and quality of care—what he dubbed “the problem-oriented medical record.”1,2 My internal medicine house officer training at Massachusetts General placed a high value on efficient, effective medical records and communication…
With the 2018 ACR/ARHP Annual Meeting nearly upon us, the time has come to plan your trip to Chicago. The Annual Meeting is Oct. 19–24 at McCormick Center, which means attendees will see beautiful views of Lake Michigan and the Chicago skyline, highlighting the city’s unique architecture. The weather in October, although unpredictable, is generally…
In a first-of-its-kind report card, the ACR shows that many changes are needed for states to improve patient access to affordable and effective rheumatology care…
Evidence suggesting common inflammatory pathways in RA and depression is increasing. However, this study found that improved physical health through pharmacologic treatment does not by itself improve mental health. …
Uveitis is an inflammation of the uvea, which comprises the iris, ciliary body and choroid. Uveitis can lead to ocular damage and complete visual loss. Noninfectious etiologies for uveitis are the most common in the U.S.1 The estimated incidence of uveitis ranges from 25–52 per 100,000 in adults and five per 100,000 in children. The…
Managing the administrative work necessary to keep members of the Virginia Society of Rheumatologists (VSR) active and engaged was proving a challenge for volunteer rheumatologists balancing their society activities with busy practice schedules. After attending several other state society meetings and talking to society leaders about the value of creating an executive director role, VSR…
The disease called systemic lupus erythematosus (SLE) went through many different stages of classification before reaching the modern criteria reflecting our current understanding of its pathogenesis. In 1872, the Viennese dermatologist Moriz Kaposi, MD, published a paper, “New Contributions to Knowledge of Lupus Erythematosus,” which provided a significant leap forward in the characterization of this…
Systemic lupus erythematosus (SLE) is a heterogeneous, autoimmune, inflammatory, connective tissue disease affecting multiple organs. Neither central nervous system nor peripheral nervous systems are spared. The neurologic system is involved in a wide range of 10–80% of patients with SLE. Peripheral neuropathy, such as Guillain-Barré syndrome (GBS) and its variants, can occur in neurologic complications…
Over time, systemic lupus erythematosus (SLE) can lead to considerable organ damage. Preventing this outcome is complicated by a scarcity of treatment options that can drive the disease into remission and by the side effects of existing therapies, such as prednisone and other corticosteroids, which may themselves contribute to the long-term damage. The largest study…
Systemic lupus erythematosus (SLE) is a leading cause of death among young women, according to an August 2018 study in Arthritis & Rheumatology.1 To help determine where SLE ranks among causes of death, Eric Y. Yen, MD, and Ram Raj Singh, MD, conducted a population-based study using nationwide mortality counts for all female residents of…
Hazel L. Breland, PhD, ORT/L, FAOTA, CLA, assumes the role of ARHP president in October. She is the 50th person to hold that honor, and the organization’s first African-American leader. “Several things came together at one time that I didn’t necessarily think about when I was asked what my aspirations in the organization were in…
With the wind in her hair and a smile on her face, a young girl flies through the air on the zip line at Camp Wekandu. She waves to her fellow campers on the ground and offers a thumbs up before the ride ends and one of the camp counselors lowers her from the zip…
Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of malignancies, leading to better cancer treatment outcomes and patient survival. However, the emergence of autoimmunity has been a major adverse event resulting from ICI use. Below, we describe a patient who experienced a flare of preexisting psoriasis and new-onset severe psoriatic arthritis after…
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a heterogeneous, inflammatory, musculoskeletal disease. The disease is an insidious, sterile osteitis with associated skin and synovial inflammation.1 Diagnosis can prove challenging, but a thorough clinical history, high clinical suspicion and imaging techniques can help clinch it. The below case reveals a rare, fulminant presentation of…
Relapsing polychondritis (RPC) is a systemic and, in some cases, fatal disease. Dyspnea with findings of small airway disease—even in the absence of the more commonly associated tracheobronchial abnormalities or pathognomonic clinical findings, such as saddle nose and cauliflower ear—may be presenting signs and symptoms of relapsing polychondritis. Below, we present a case demonstrating that…
Palindromic rheumatism (PR) was first described in 1944 as “unique in its nature of recurrent, transient episodes of excruciatingly painful inflammation of articular and periarticular tissues, followed by periods without symptoms.”1 Unfortunately, it is becoming evident this entity is more frequent than we thought.2 PR is easily ignored or misdiagnosed due to its character (i.e.,…
Rheumatoid arthritis (RA) can be typed, grouped and categorized in different ways, and subgroup identification could help guide future research and treatment strategies based on which subtypes respond to which treatment. A new study explored an approach associating gene expression profiling with histologic analysis of synovium samples to define RA subtypes and then examined how…
A confluence of advances in knowledge and technology is closing in on the day when therapies for patients with rheumatoid arthritis (RA) may be specifically targeted to the precise variant and stage of disease. “Precision medicine is in the future, and not the distant future but more in the immediate future,” says Harris R. Perlman,…
How will big data mined from huge sample sizes in research cohorts, electronic health records, personal health data (e.g., heart rates from Fitbits) and insurance claim data sets change the way physicians interpret something as simple as complete blood count (CBC) test results for individual patients? According to the authors of a paper in the…
For patients with rheumatoid arthritis (RA) who respond to subcutaneous tocilizumab, discontinuing methotrexate may be an option and offer an alternative to patients who cannot tolerate or prefer not to take methotrexate. “This is one of the first studies showing that methotrexate may be discontinued in a cohort of patients with a biologic agent without…
A recent study in Arthritis & Rheumatology highlights new information about the epidemiology and disease course of the vasculitic disease granulomatosis with polyangiitis (GPA, formerly known as Wegener’s disease).1 GPA is a rare disease that’s generally specific to the lungs, kidneys and the upper airways. The study provides key new data about the incidence and…
A note from ARP President Hazel L. Breland, PhD, OTR/L, FAOTA: Some time has passed since the ACR first published its NP/PA Rheumatology Curriculum Outline. Originally developed to serve as a guide for rheumatologists to onboard a nurse practitioner (NP) or physician assistant (PA) into the rheumatology practice setting, the ACR has realized this valuable resource…
Rheumatology in China is a relatively young discipline, but it has developed exponentially over the past three decades. In this article, we review the history of rheumatology in China and advances in clinical care, research and education in this field. The Founding Father Naizheng Zhang, MD, is widely regarded as the father of rheumatology in…
Mounting evidence suggests that humans have a complex and integrated mind-body system. Knee problems may affect the spine and other body parts, but also the mind—and vice versa. This is the wisdom of Ayurveda, the 3,000-year-old traditional medicine from India. A team of researchers from Germany recently undertook a study, titled “Effectiveness of an Ayurveda…
Patients with polymyalgia rheumatica (PMR) or peripheral arthritis may require extra vigilance during treatment because of a suspected link to giant cell arteritis (GCA) and, potentially, permanent vision loss. “Development of giant cell arteritis after treating polymyalgia or peripheral arthritis: a retrospective case-control study,” a March 2018 study published in The Journal of Rheumatology, suggests…
A patient with rheumatoid arthritis (RA) comes to your office and needs a medication. You prescribe it, and the patient’s insurance plan covers it. The patient begins the medication and slowly but surely feels better. Prescribing drugs for a patient should be this simple but rarely is, thanks to the high cost of drugs and…
It has long been known that hyperlipidemia adversely affects bone, but the exact pathologic mechanism(s) underlying hyperlipidemia-induced bone loss has not been fully understood. Until now. Pathogenesis of Osteoporosis New research by Ambrogini and colleagues shows that oxidation-specific epitopes derived from lipid peroxidation contribute to the pathogenesis of osteoporosis.1 Importantly, the research shows that innate…
Physicians already know a great deal about Sjögren’s syndrome’s symptoms and potential complications, and a new study confirms data on two long-suspected predictors of progression (i.e., measurable phenotypic findings) that could show which patients are likely to progress to active disease: hypergammaglobulinemia and hypocomplementemia. Published in the February issue of Arthritis Care & Research, “Natural…
Severe infections occurred in 25% of patients with anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV) who were treated with rituximab, according to results of an observational study conducted in the United Kingdom (U.K.) and Austria. Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, however, reduced the risk of severe infections, the investigators reported in Annals of the Rheumatic Diseases.1 Andreas…
New research explores the genome-wide epigenetic changes associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The results suggest distinct patterns in DNA methylation may become a useful diagnostic marker…
The early identification of endothelial dysfunction may be useful in clinical practice to prevent SLE patients from developing atherosclerosis and cardiovascular disease. New research evaluated the use of peripheral arterial tonometry in assessing endothelial dysfunction in patients with early SLE and no cardiovascular risk factors or disease. The results: These patients showed a high rate of endothelial dysfunction and vascular stiffness…
Canadian Pediatric Rheumatologist Invested into Order of Canada Peter Dent, MD, professor emeritus of pediatrics at McMaster University in Hamilton, Ontario, Canada, was invested into the Order of Canada in May. The Order of Canada is the country’s highest civilian honor. “Dr. Dent has had a substantial positive impact on healthcare, in Hamilton and far…
“I think I’m mentally sharper when I have been exercising and taking care of myself,” says Chris Phillips, MD, a rheumatologist in solo practice in Paducah, Ky. Dr. Phillips has recognized these benefits since high school, when he began participating in competitive sports. Four years ago, Dr. Phillips was competing against 40 other cyclists in…
You are seeing a hospital consult late in the afternoon on a Saturday. The patient has suspected, new-onset lupus with inflammatory arthritis, renal failure with nephrotic range proteinuria and a malar rash. You plan to start the patient on high-dose IV steroids, and you decide to speak to the nephrologist on call first. When he…
The FDA has not approved extended release Remoxy, a gel capsule formulation of oxycodone, concluding that its potential benefits do not outweigh its risks…
In late July, the European Commission granted marketing approval for Hyrimoz, which is biosimilar to adalimumab…
The Rheumatology Research Foundation has received a major donation from Audrey M. Nelson, MD, a retired rheumatologist from the Mayo Clinic in Rochester, Minn. The Audrey M. Nelson, MD, Pediatric Rheumatology Fellowship Endowment in Training will support training awards for pediatric rheumatology fellowships. This generous donation addresses the growing demand for pediatric rheumatologists to ensure…
The ACR/ARHP is very pleased to announce that all scientific attendees at the 2018 ACR/ARHP Annual Meeting will receive a complimentary one-year subscription to ACR Beyond streaming (a $279 value). This complimentary subscription includes not only all of the recorded sessions from the 2018 ACR/ARHP Annual Meeting, but also more than 500 sessions from past…
Do you remember the 1959 movie, The Mouse That Roared? Through a few small actions, the Duchy of Grand Fenwick, a small, often overlooked principality, becomes a superpower on the world map overnight. In many ways, rheumatology has been in the same position. We are a small specialty; we don’t have well-known diseases. Although our…
Systemic lupus erythematosus (SLE) is more prevalent among Hispanic women than white women, according to two recent studies published in Arthritis & Rheumatology.1,2 However, Latinas often lack awareness of lupus, which can contribute to delays in diagnosis and treatment, and lead to worse outcomes. “One of the challenges is reaching out to the Latino community,…
On Sept. 12, the ACR and the Sjögren’s Syndrome Foundation presented an ICD-10 code change request for Sjögren’s syndrome to the ICD-10 Coordination and Maintenance Committee (C&M) at the CMS office in Baltimore. The request is intended to clarify ICD-10 M35.0: sicca syndrome [Sjögren]. Why Change the Code? The rationale behind this significant change request…
Maintaining a health revenue cycle in a medical practice comes with myriad moving parts. Numerous external forces, such as economic conditions, government programs (e.g., the Zone Program Integrity Contractor [ZPIC], the Health Information Technology for Economic Clinical Health [HITECH]) and legislation passed under healthcare reform, mandate healthcare organizations to begin managing internal processes, such as…
1. A 45-year-old female patient with a diagnosis of primary osteoarthritis returns to the office for her second scheduled injection of sodium hyaluronate (Supartz). The nurse takes the patient’s vitals: weight is 185 lbs., height is 5’2”, and temperature is 98.2°F. The patient is prepped and given the injection. How should this encounter be coded?…
Take the challenge. B or D—If it was not documented, it was not done is the motto of many coders. For those who follow this motto, the answer would be B. But there is another option for the coder and that is to query the physician about whether the injection was done with ultrasound guidance…