While medical advances in rheumatoid arthritis (RA) have led to improvements in disease control and quality of life for patients worldwide, the rate for stable remission remains low.1 Management of RA symptoms is traditionally accomplished through a combination of medications and nonpharmacological interventions.2 This approach can prevent the development of secondary adverse health outcomes. Two…
Systemic sclerosis (SSc) is a disease characterized by immunologic abnormalities, microvascular involvement and tissue fibrosis. In previous studies, 10-year survival rates ranged from 50–84%. However, there are concerns that these studies, using prevalent cohorts, are underestimating mortality. “While the prognosis of many rheumatic diseases has improved with the availability of more effective and targeted therapies,…
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…
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…
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…
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…
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…
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…
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,…
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….