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From: The Rheumatologist, July 2011
Features
How Energy Shifts Lead to Systemic Illness
The impact of adaptive energy programs on the manifestations of chronic inflammatory disease
Why do chronic inflammatory diseases (CIDs) such as rheumatoid arthritis (RA) or systemic lupus erythematosus affect the whole body and produce myriad debilitating and disabling symptoms that make people sick? Is this clinical pattern of systemic involvement an unfortunate byproduct of sustained inflammation or, in an unexpected way, is it an adaptive program positively selected during evolution?
Is It Time to Replace the HAQ?
The PROMIS initiative uses item response theory to improve assessment of patient-reported health and wellbeing
Rheumatologists and researchers who consider the Health Assessment Questionnaire (HAQ) the gold standard for measurement of self-reported health status may not want to give it up for a new system. However, the person who was instrumental in creating and launching the HAQ in 1980 says that the time is coming when it can be replaced with something much better, thanks to the National Institutes of Health (NIH)–funded Patient Reported Outcomes Measurement Information System (PROMIS) initiative.
A Duet of Bone and the Immune System
Examining emerging perspectives in osteoimmunology
Over the past two decades, exciting research has provided an important new perspective on the biology of bone in health and disease, revealing an active and sometimes loud crosstalk between bone and the immune system. This perspective is a radical departure from the traditional view of the relationship of these tissues. In the traditional view, the bone and immune system represented separate functional realms despite their close physical relationship in the bone marrow. There, the bone houses immune cells...
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News
Revising Fibromyalgia: One Year Later
The 2010 ACR fibromyalgia criteria capture the broader clinical picture and help ensure more appropriate diagnosis and management by primary care
What do rheumatologists consider to be fibromyalgia when they diagnose it in practice? Answering this question was the basis for the “ACR preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity,” published in May 2010.
Innovation Brings Specialist Services to the Underserved
Project ECHO trains general practitioners and midlevel providers in the basic arts of rheumatology
Should you be driving through New Mexico and see a sign that says, “Last Gas for 50 Miles,” take it seriously. The scarcity is very real. New Mexico, known as the Land of Enchantment, is the fifth largest state in the union, yet is home to a half million fewer souls than live in the jam-packed 72 square miles of Brooklyn. Practicing medicine in this enchanted land of often sublimely beautiful, profoundly empty, wide-open spaces are exactly 19 rheumatologists. That scarcity is also very real,...
Is Ultrasound Right For YOUR Office?
Growth of ultrasound for rheumatic diseases leads many to wonder how it might fit into their practice
The uses of ultrasound (US) technology in rheumatology have been growing in importance over the last few years. Many rheumatologists are beginning to explore the possibility of adding US to their practices.
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From the College
Pain Perspective in Scleroderma
Systemic sclerosis (SSc; scleroderma) is a disease in which inflammatory and fibrotic changes result in overproduction and accumulation of collagen and other extracellular matrix proteins, resulting in intimal vascular damage, fibrosis, and occasionally organ dysfunction affecting the gastrointestinal, lung, heart, and renal systems. There are two classifications of SSc—limited cutaneous or CREST (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangectasias) syndrome, where...
RheumPAC: It's Not About Politics
The best thing about RheumPAC is that it’s not political.
To Fix Health Policy, You (Yes, You) Have to Get Involved
I can’t tell you how many times I have conversed with a colleague about the state of health policy and heard, “It’s broken.” I invariably have to ask, “What have you done to fix it?” Often times I get a blank stare or an excuse about how Congress doesn’t listen.
Coding Corner Answer
July’s Coding Answer
Coding Corner Question
July’s Coding Challenge
In this month’s coding article, the topic is the Zone Program Integrity Contractor (ZPIC) audits (see Practice Page, for more on these audits). The following questions will help test your knowledge on appeals and denials.
Honorary Member Joan “Happy” Tyree Retiring
Staff member Joan “Happy” Tyree has worked in arthritis since May 1982, when she joined the staff of the ACR. She began her career with the ARHP in August 1984. During her years at the ARHP, she has worked in membership and educational programs, coordinating the development of more than 26 ARHP Annual Scientific Meeting programs.
2011 ILR Request for Proposals
The International League of Associations for Rheumatology (ILAR) is issuing its fourth request for proposals for projects that advance rheumatology in developing countries.
Practice Page
ZPIC Medicare Audits: What’s in Store for Physicians?
The Centers for Medicare and Medicaid Services (CMS) has a new audit program: the Zone Program Integrity Contractor (ZPIC) Audits. During the past year, CMS started to implement this program to wrestle with the large problem of fraud and abuse.
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Departments
Is the Electronic Health Information in Your Practice Really Safe?
The Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program (Meaningful Use) provides for eligible physicians who demonstrate “meaningful use” of certified EHR technology to be eligible to receive up to $44,000 in Medicare incentive payments over five years or up to $63,750 in Medicaid incentive payments over six years. But what does it really mean to achieve “meaningful use” for the EHR Incentive Program, and what will your practice need to...
Essential Evidence Plus
Tools and Alerts For Clinicians Who Deliver First-Contact Care
Knuckle Cracking Not Associated with Increased Risk of Hand Osteoarthritis; Use of Opioid Analgesics in Early Pregnancy Associated with Birth Defects; Capsaicin Gel and SAMe Improve Pain in Patients with DJD; Exercise and Diet Good Even for Frail, Obese Elderly; Low Risk with Estrogen Therapy in Postmenopausal Women with Prior Hysterectomy After 10.7 Years; Antidepressants of Uncertain Effectiveness in Patients with Depression Plus Dementia; Risk of Lymphoma Not Increased Among Patients with Inflammatory...
Office Visit
Epidemiology makes a career of studying arthritis health disparities for Leigh Callahan, PhD
While growing up, researcher Leigh Callahan, PhD, had no specific blueprint for a future career, but her love for math as a youngster eventually drew her to a profession that suits her well.
Rheum with a View
Panush’s perspectives on selections from the literature
How many times do we write this or see this recorded or presented without really carefully examining the eye or the fundus? How many of us still look at the fundus? Most medical residents don’t even carry or own ophthalmoscopes and have little comfort with the exam of the eye or fundus. This leads me to the new recommendations regarding antimalarials. Recently, my college and medical school roommate, Marty Pearlman, MD, and his wife visited my wife and me. Marty went into ophthalmology and now does...
Drug Updates
Information on New Approvals and Medication Safety
Belimumab (Benlysta) for the treatment of active, autoantibody-positive systemic lupus erythematosus (SLE) in patients who are receiving standard therapy has received a positive opinion from European regulators recommending its approval. Belimumab is administered by intravenous infusion and is the first B-lymphocyte stimulator protein inhibitor to be approved by the U.S. Food and Drug Administration (FDA). The last SLE drugs to be FDA approved were hydroxychloroquine and corticosteroids.
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Columns
It Takes All Kinds
A look at the rheumatology practice team
The care of patients with rheumatic diseases requires physicians and health professionals with the experience and knowledge of complex rheumatic diseases. The collaboration of physicians, nurse practitioners, physician assistants, social workers, cognitive behavioral therapists, physical therapists, and others allows for the optimum outcomes for our patients. This month the ACR and the ARHP presidents are collaborating to describe the members of the rheumatology practice team and the roles they fill in the...
Treat-to-Target Decisions and Dilemmas
A better understanding of targets can lead to better outcomes down the road
Reflecting on recent progress in the treatment of inflammatory arthritis, I am especially gratified by the concept of treat to target (T2T). T2T places our specialty smack in the mainstream of modern medicine. After all, much of internal medicine is based on T2T, whether the target is blood pressure, glycosylated hemoglobin (hemoglobin A1C) levels, or the international normalized ratio (INR). As a scientist, I like numbers, and I welcome them to our specialty. The more the better. Interestingly, some...
High Cost, No Benefit
Why are so many brand-name drugs approved after generic versions become available?
These are tough times for everyone in healthcare in the U.S. Due to skyrocketing healthcare costs, insurers are clamping down on access to studies and treatments that could improve outcomes. Pharmaceutical companies have higher hurdles to clear in order to get drugs approved, and those drugs that are approved are watched with increasing scrutiny by the government, public, and litigators. In this environment, pharmaceutical companies could reach for low-hanging fruit by repackaging already-available...
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Viewpoints
Letters: Feedback from Our Readers
Rheumatology and NPs/PAs in Local Practice Models; Family Connections
