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From: The Rheumatologist, April 2011
Features
Immunosuppressive Treatment for Lupus in the Next Decade
It’s time for a new strategy
An 18-year-old woman first presented with findings of systemic lupus erythematosus (SLE) including arthritis, fever, photosensitivity, hair loss, oral ulcers, Raynaud’s phenomenon, mild leukopenia, and thrombocytopenia. Antinuclear antibodies and anti-dsDNA were positive, but there was no evidence of nephritis. She was treated with low-dose glucocorticoids and hydroxychloroquine. A few months later, she developed lower-extremity edema, and her urinalysis showed an active urine sediment and...
The LUMINA Study
Impact beyond lupus in U.S. Hispanics
A 20-year-old Mexican woman presented to a local health facility in Corpus Christi, Texas, complaining of three days of difficulty in breathing and chest pain on inspiration. A month prior to the onset of these symptoms, she had delivered a healthy baby boy. Of note, she was in good health prior to the pregnancy, and her pregnancy and delivery had been uneventful. However, she had not received any routine prenatal care. Her physical examination at the presentation to the health facility was negative. She...
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News
Lupus Nephritis Guidelines in Progress
A preview of the upcoming recommendations
A team of rheumatologists, nephrologists, and pathologists is currently at work on the first-ever ACR guidelines for the screening, diagnosis, and treatment of lupus nephritis. The new guidelines are scheduled for publication this fall and will review modern studies that meet standards of high levels of evidence as well as expert opinion to make recommendations for use by rheumatologists in clinical practice.
Gabriel to Chair Healthcare Reform Panel
Former ACR president assigned key role in transforming nation’s healthcare system
Former ACR president Sherine E. Gabriel, MD, MSc, has long been at the forefront of patient-centered clinical research designed to enhance the effectiveness of treatment of rheumatoid arthritis and other rheumatic conditions. Now, Dr. Gabriel, who is professor of medicine and epidemiology and the William J. and Charles H. Mayo Professor at the Mayo Clinic in Rochester, Minn., has been asked to apply her expertise and leadership to improving outcomes across the full gamut of healthcare in the United States.
Opioids More Dangerous than other Analgesics for Elderly
Safety events vary among different opioids
In the past few years, the use of opioids to treat arthritis pain has increased dramatically because of concerns with the risk of cardiovascular disease and other side effects with nonselective, nonsteroidal antiinflammatory drugs (nsNSAIDs) and selective cyclooxygenase-2 inhibitors (coxibs). Despite the widespread use of these agent, there have been few data available on the comparative safety profile of opioids. Now, two studies by Solomon et al published in the Archives of Internal Medicine show that...
Behind the Digital Door
Rheumatology practices work toward becoming “meaningful users” of EHRs
An extensive campaign by the federal government to encourage medical professionals to make their office records electronic has many rheumatologists wondering if now is the time to make significant investments in computer equipment and software.
New Guidance for Rheumatologists who Treat JIA
Evidence and consensus-based recommendations reflects current knowledge about initiation of therapy
Recent advances in the treatment of juvenile idiopathic arthritis (JIA) have dramatically improved outcomes for children with these conditions. To provide an evidence base for treatment for JIA, an analysis of these advances has been presented in the recently published “2011 ACR recommendations for the treatment of juvenile arthritis.” These recommendations represent the development, for the first time, of validated guidance regarding the safest and most effective treatment of this chronic...
A View of Industry from the Inside
Rheumatologists with pharmaceutical careers discuss the path that led them to industry and the work they do
I didn’t go into medicine to be a mouse doctor,” says Barbara K. Finck, MD, recalling a time early in her career when she was working on murine models of lupus erythematosus and gaining a reputation as a top-tier mouse immunologist. She had always been interested in scientific research, she says, and the ability to transition from an idea to the laboratory to the clinic is a real interest of hers. She had an opportunity to go to into the pharmaceutical industry, and she took it. Within several...
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From the College
Measuring Up for Meaningful Use
The Centers for Medicare and Medicaid Services’ (CMS’) Electronic Health Record (EHR) Incentive Program—Meaningful Use—requires that eligible providers participating in the incentive program successfully demonstrate meaningful use of the EHR system by reporting on a set of core and menu functional objectives to qualify for incentive payments of up to $44,000.
2011 ACR/ARHP Annual Scientific Meeting Takes You to Chicago
Join us November 4–9, 2011, in Chicago for the ACR/ARHP Annual Scientific Meeting. This exciting, friendly, and charming city is world famous for its arts and entertainment, food, architecture, and shopping. Chicago’s great magic lies in its mix: sophisticated yet friendly, bustling city streets adjacent to long stretches of green parks, and sparkling blue Lake Michigan. This year’s meeting, which will be held at McCormick Place West, is only a few miles from the hustle and bustle of the...
Promoting Arthritis Research to Congress and Others
The ACR works to promote clinical and basic research in arthritis and musculoskeletal disease through a variety of channels, including advocacy, working directly with the National Institutes of Health (NIH), and through the work of the ACR Research and Education Foundation.
Coding Corner Question
April’s Coding Challenge
Mary, age 51 years, returns to the rheumatology office for a follow-up visit for her diagnosis of rheumatoid arthritis. The physician takes a detailed history and performs an expanded problem-focused exam. The medical decision is of low complexity. During the visit, the patient complains of stiffness and swelling in the left hand, elbows, and neck. The rheumatologist performed an X-ray of the left hand, two views, and reads the results during the visit. Because of the severity of the swelling, the...
Coding Corner Answer
April’s Coding Answer
Student Benefits from Resident Research Preceptorship
Although the ACR Research and Education Foundation offers a number of opportunities to students interested in rheumatology, the Ephraim P. Engleman Endowed Resident Research Preceptorship is a unique opportunity that allows for a much more in-depth learning experience. The purpose of the Engleman Preceptorship is to introduce residents to the specialty of rheumatology by supporting a full-time research experience, with the goal of attracting promising physician–scientists to the field of rheumatology...
RheumPAC: Advance Rheumatology on Capital Hill
One way to succeed in our mission of advancing rheumatology is to increase the ACR’s presence on Capitol Hill through grassroots and direct lobbying. However, for the rheumatology subspecialty to be most effective we must use all tools available to us, including RheumPAC, the ACR’s nonpartisan political action committee. RheumPAC demonstrates to members of Congress that the rheumatology subspecialty is committed to political action, educating policy makers, and improving healthcare for our...
Documenting the Patient's Story: Consider a Scribe
You probably prefer to spend less time documenting a patient visit and more time actually interacting with the patient, right? If so, you may want to consider hiring a scribe.
Practice Page: Cross-Train Staff to Improve Practice Management
Cross-training practice staff can enhance office functionality and ensure good customer service
Having a well-rounded staff is beneficial to you and your patients and can lead to higher productivity and enhanced team spirit. Building your staff starts with hiring people who are efficient and have the desire to learn. Be sure to let potential employees know up front that cross-training will be a part of their job function to set the expectation.
Tips for Signature Requirements for CMS
In an effort to minimize medical fraud and abuse, the Centers for Medicare and Medicaid Services (CMS) has updated the signature guidelines for physicians and medical documentation.
more From the College
Departments
Essential Evidence Plus
Tools and alerts for clinicians who deliver first-contact care
Pediatrics; Spinal Stenosis; Low Back Pain; Delerium; Reducing Mortality
Rheum with a View
Panush’s perspectives on selections from the literature
There was a piece in the literature recently about the illness of the musician Frederic Chopin. A favorite interest of mine has been rheumatology (and medicine) in history, literature, art, music, and biblical lore. I find it fascinating to try and understand how illness affected great artists, leaders, and history. Some examples include:
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Columns
Are We There Yet?
Advancing rheumatology through public relations
We’ve all likely traveled with someone who repeatedly asks, “Are we there yet?” Perhaps we’ve even been the person posing the question. It is usually a question rooted in sheer excitement for what the end destination holds, and it is a question that is often met with the answer, “Not yet, but we are getting closer.”
Trillions of SNPs Versus a Glass of Grappa
Will personalized medicine make us healthier or just contribute to information overload?
At a meeting I attended recently, I heard a series of dazzling talks on human genetics. The meeting was held in a venerable and majestic city in Europe, but the venue was a modern hotel near the airport. Unlike some European hotels that provide only one towel—a veritable washcloth—this place was downright American in the luxuriousness of the drying equipment. Three large expanses of fluffy white cotton along with hand towels and bars of free soap decorated my bathroom. Apparently, the Green...
Treat Rheumatoid Arthritis to Target
The time has come for goal-directed management of RA
The goal of “treating to a target” is not a new concept in clinical medicine. Indeed, in many specialties, goal-directed treating to target is already the standard. For example, the goal of reducing low-density lipoprotein is widely accepted and followed by cardiologists and primary care physicians (PCPs), as determined by the number of coronary artery disease risk factors present in each patient. The Joint National Commission (JNC) 7 blood pressure guidelines have also been widely adopted by...
