Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease. Although RA develops its central pathology within the synovium of diarthrodial joints, many non-articular organs can be involved, particularly in patients with severe joint disease.1 Although most patients are asymptomatic, cardiac involvement is relatively common and includes rheumatic heart nodules, pericarditis (30–50%), pericardial effusion and…
The cards sat, untouched, in a corner of my desk. In the 1800s, it was common for American saloons to provide patrons with a free meal. Of course, the meal came with a catch: The meals were predictably salt laden and designed to encourage patrons to drink more beer. Hence was born the expression, “There…
In 2004, the British Medical Journal published an article titled, “Resisting Cookbook Medicine,” which looked askance at the “routine use of predetermined directives” in clinical practice because it reduced doctors to practicing so-called cookbook medicine and eroded the art of medicine.1 Fast forward 15 years, and we find our appetite for “predetermined directives”—what we now…
Apremilast was first marketed in March 2014 for the treatment of adults with psoriatic arthritis (PsA). An immunomodulating drug, which is a small molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP), apremilast is administered orally. By inhibiting PDE4, intracellular cAMP levels are increased. Although the exact mechanism of action is not…
Rheumatologists want to be the best clinicians possible, provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In the Lessons from a Master Clinician series, we offer insights from clinicians who have achieved a level of distinction in the field of rheumatology. Michael H. Weisman, MD, is a professor…
When I first met Ms. Miller (name changed), quite frankly, I couldn’t wait to get out of the room. I’m sure she couldn’t either. A woman in her 40s with systemic lupus erythematosus, poorly controlled asthma and fibromyalgia, she seemed to have every conceivable symptom. And, worse than that, due to a long history of…
The traditional model for subspecialist consultations on hospitalized patients by outpatient-based rheumatologists may seem straightforward. Hospitalists (the inpatient specialists who now manage most in-hospital medical care in the majority of U.S. hospitals) typically call upon the rheumatologist’s expertise for joint swelling and a rash or fever of unknown origin, says Lianne Gensler, MD, of the…
Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis. SRC occurs in 2–15% of patients with diffuse sclerosis and usually within the first five years from the time of diagnosis. Risk factors for SRC include, but are not limited to, early diagnosis, corticosteroid or cyclosporine use, and the presence of anti-RNA polymerase III…
More than 72,000 Americans died from opioid overdoses in 2017, according to the National Institutes of Health.1 The impact of the opioid epidemic has affected many levels of patient care and, as a result, healthcare systems are responding to escalating death rates, new legislation and the possibility of compromised patient safety in a multitude of…
A new program, The Training Rheum provides specialized instruction for NPs & PAs starting their career in rheumatology. Learn more from attendees and instructors of the premiere event held in Atlanta…
The identification of specific transcription factors linked to the Epstein-Barr virus (EBV) provides new information on the molecular mechanisms underlying the link between EBV and autoimmune disease. A recently published study, “Transcription Factors Operate Across Disease Loci, with EBNA2 Implicated in Autoimmunity,” co-led by John B. Harley, MD, PhD; Leah C. Kottyan, PhD; and Matthew…
A new podcast from the ACR provides in-depth discussions about newly published science, regulatory updates, advocacy and volunteer opportunities for the rheumatology community…
How laboratories define a serological hallmark of systemic lupus erythematous and which assays they use to detect it could contribute to misclassification of patients identified as anti-nuclear antibody (ANA) negative, according to researchers. Most people who have lupus test positive for ANAs as part of an immunology screening for autoimmune disorders. The presence of ANAs…
People with or at risk for symptomatic knee osteoarthritis (OA) may be assigned to four depression subtypes with distinct clusters of depressive symptoms that may affect pain and disability over time, according to a new study in Arthritis Care & Research.1 Four depression subtypes were identified in the study using the Center for Epidemiologic Studies…
A patient with rheumatoid arthritis (RA) asks if diet can help ease their symptoms. Or maybe a patient with severe knee osteoarthritis (OA) seeks diet advice because they want to lose weight and relieve pressure on their joints. Although there’s no specific nutrition plan for patients with rheumatic diseases, research has shown many dietary factors…
MADRID—During the 2019 European Congress of Rheumatology (EULAR), held June 12–15, speakers addressed the complexity of vasculitis in a Challenges in Clinical Practice session titled, How to Maintain Remission in Vasculitis. Although vasculitis appears in many varieties, one commonality exists among these related yet distinct conditions: When there is vital organ or systemic involvement, disease…
MADRID—Rheumatoid arthritis (RA) is among the most common autoimmune diseases in the U.S., affecting approximately 1.3 million U.S. adults.1 Although tremendous treatment advances have been made in recent years, one extra-articular manifestation of RA that continues to pose a challenge with regard to detection and management is interstitial lung disease (ILD). At the 2019 European…
Accurately classifying patients with psoriatic arthritis (PsA) can be difficult, especially patients with monoarticular/oligoarticular and polyarticular forms of PsA. A session at the 2019 European Congress of Rheumatology provided insight into the assessment and treatment of PsA subtypes…
For patients with gastrointestinal (GI) manifestations of scleroderma, the effect on quality of life & longevity can be dramatic. But advances are being made in the diagnosis & treatment of these patients…
A recent study in The Journal of Rheumatology sheds light on the importance of preconceptional cardiovascular health in women with systemic lupus erythematosus. Although many questions remain, improved cardiovascular health measures seem to positively affect pregnancy outcomes, suggesting a potential role for preconception cardiovascular interventions.1 Women with lupus now have healthier pregnancies than in the…
Scleromyxedema is a rare, mucinous skin disorder of unknown origin, one of a number of conditions that mimic systemic sclerosis. Although cases of scleromyxedema remain rare, a better understanding of its mechanisms of action could have implications for the research and treatment of scleroderma and related autoimmune conditions, says Laura K. Hummers, MD, ScM, co-director…
The opioid epidemic in the U.S. has destroyed thousands of lives and torn families apart. According to the Centers for Disease Control and Prevention, an average of 130 people in the U.S. die each day from an opioid overdose. From 1999 to 2017, more than 700,000 died as a result of drug overdoses. In 2017,…
A 43-year-old woman is establishing care in your new urban clinic after her previous rheumatologist stopped accepting her Medicaid insurance more than a year ago. Since that time, she has been trying to find a new rheumatologist who will accept Medicaid. She lives 90 miles away in a small town without a rheumatologist. Seven years…
Hadlima (adalimumab-bwwd), which is biosimilar to adalimumab, is now FDA approved to treat multiple autoimmune diseases…
Results from multiple phase 3 clinical trails have led to the FDA approval of upadacitinib to treat patients with moderate to severe active RA…
Secukinumab therapy proved safe and effective for psoriatic arthritis patients with multiple co-morbidities and long treatment histories, according to recent research…
Another exciting ACR/ARP Annual Meeting is planned for this November. Show your support for the Foundation’s mission and enjoy your time in vibrant Atlanta at one of the Foundation’s events. Donations made to the Foundation support the extensive awards program that funds research, training and education opportunities for current and potential rheumatologists and rheumatology professionals…
The ACR is known for excellence in rheumatology education—and 2019 will be no exception. This year’s annual meeting offers innovative session formats and user-friendly, interactive approaches to learning…
From insights into mentoring and statistics to integrating virtual reality into a patient’s rehab—the educational sessions offered during the ACR/ARP Annual Meeting will be practical, yet innovative and inspiring…
At this year’s ACR/ARP Annual Meeting, Nov. 8–13, all of the pediatric rheumatology sessions will take place in the same room, making it easy to access all of the exciting content. Planners hope this convenient setup facilitates networking before and after symposia. “In pediatric rheumatology, we are very tight-knit community. This [event] is our opportunity…
A code change in the ICD-10 classification for Sjögren’s syndrome was approved by the ICD-10 Coordination and Maintenance Committee in July 2019 and becomes effective October 2020.
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…