Ankle arthritis is a debilitating condition that leaves many patients in severe pain and greatly limits their activities. Until recently, the standard treatment for bone-on-bone ankle pain has been ankle fusion, or arthrodesis, in which surgeons literally fuse the bones of the ankle joint together. However, in the past few years, total ankle replacement surgery,…
NEW YORK (Reuters Health)—The American College of Physicians (ACP) has issued a baker’s dozen of recommendations intended to guide the effective use of telemedicine in primary care settings. “The recommendations balance the potential benefits and expanded use of telemedicine with the importance of maintaining the patient-physician relationship and patient safety,” Hilary Daniel from American College…
What struck me first as I walked by the exam room where Lynn P. sat was the swelling in her fingers and wrists. The bloated hands rested unnaturally on her thighs, palms up, fingers slightly flexed. Her strawberry-blond curls were offset by a high-neck, loose-fitting, burgundy sweater. Her pale skin matched her trim slacks. She had…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis (p. 63). Before you turn to the discussion, examine these images carefully and draw your own conclusions. History For the discussion, click here. A 55-year-old man on…
View the question. Findings/Diagnosis The AP radiograph of the left hip (see Figure 1) shows periarticular, well-defined erosions of the left hip (white arrow) without joint space narrowing or osteophytes. There is no fracture. There are surgical clips and a calcified mass in the right hemipelvis (black ellipsis), representing a failed renal transplant. The coronal STIR…
ROME, Italy—Even with classification criteria that have been updated and refined over time, rheumatoid arthritis is still a diagnosis that ultimately has to be made with clinical judgment, said Ronald van Vollenhoven, MD, PhD, professor of medicine and chief of clinical therapy research in inflammatory diseases at the Karolinska University in Sweden. His remarks came…
A growing understanding of the immunomodulatory effect of the autonomic nervous system (ANS) is edging closer to having clinical applications that could one day benefit patients with rheumatoid arthritis (RA). Researchers pursuing this as an alternative path to biomarkers are investigating whether autonomic status can be used to predict response to therapy. Seattle-area rheumatologist and…
A healthy 30-year-old Indian male was performing his routine workout in the gym when he developed giddiness and transient blackouts. He thought it was due to exercising excessively. Over the next month, he developed a low-grade fever and started feeling lethargic, to the extent that he was unable to exercise or work. He was admitted…
Antiphospholipid syndrome (APS) is an autoimmune condition characterized by hypercoagulability often manifested as recurrent thrombosis or pregnancy complications, with persistently circulating antiphospholipid (aPL) antibodies or lupus anticoagulant. Catastrophic APS (CAPS), also known as Asherson syndrome, occurs in less than 1% of cases of APS and involves occlusive microangiopathy in at least three organ systems.1 Case…
CPT code: 99214 Diagnosis: ICD-9 274.02 **ICD-10: M1A.0720 History—The history of present illness was extended. The review of systems was extended (six systems were reviewed), and two of the three elements for past family social history were documented. This makes the history level detailed. Examination—Three systems were examined. This makes the exam expanded problem focused….