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From: The Rheumatologist, August 2011
Features
T Cells in Systemic Lupus Erythematosus
Progress toward targeted therapy
Recently, belimumab, a monoclonal antibody that targets the cytokine BLyS, was the first new drug in the last 50 years to be approved by the U.S. Food and Drug Administration for the treatment of systemic lupus erythematosus (SLE). The relative lack of new therapies for SLE indicates how little we understand about this difficult disease. SLE is a disease characterized by production of autoantibodies, some of which mediate disease pathogenesis. Yet, in clinical trials rituximab, a B cell–depleting...
What Fat Does to Arthritis
The role of adipokines in the pathogenesis of rheumatic diseases
A dipose tissue has longed been viewed as a harmless tissue in the pathogenesis of chronic inflammatory connective tissue and joint diseases, with fat providing the soft surroundings for damage inflicted by other mechanisms. This dogma, based on the protective role of leptin in metabolic diseases, has long been popular, although it may have hindered thorough basic science research in this field. However, three discoveries have completely changed this point of view and will be the subject of this article.
How a Nuclear Molecule Alarms the Immune System
The role of HMGB1 in the pathogenesis of lupus nephritis
HMGB1 can serve as an alarmin. Alarmins are cellular molecules that promote inflammation and activate innate and adaptive immunity. In its activity as an alarmin, HMGB1 can interact with receptors that include receptor for advanced glycation end products (RAGE), and Toll-like receptors (TLR) 2, 4, and 9. There is increasing evidence that HMGB1 is involved in autoimmunity and chronic inflammation, as exemplified by increased levels of HMGB1 in the sera of patients with rheumatic disease. Recently, an...
A&R Abstracts - T CELLS
For Further Reading
Want to know more about the role of T cells in SLE? Check out these abstracts from Arthritis & Rheumatism, and log on to www.wileyonlinelibrary.com/journal/arthritis to read the full articles.
A&R Abstracts - ADIPOKINES
For Further Reading
Want to know more about adipokines and their role in rheumatic disease? Check out these abstracts from Arthritis & Rheumatism, and log on to www.wileyonlinelibrary.com/journal/arthritis to read the full articles.
A&R Abstracts - HMGB1
For Further Reading
Want to know more about lupus nephritis research? Check out these abstracts from Arthritis & Rheumatism, and log on to www.wileyonlinelibrary.com/journal/arthritis to read the full articles.
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News
ONLINE EXCLUSIVE: Experts discuss the process of becoming “meaningful users” of electronic medical records
Listen to Craig W. Carson, MD, an Oklahoma-based rheumatologist, discuss when his practice will apply for meaningful use incentive credits. Then, listen to Karen Hansen, Dr. Carson’s practice manager, discuss the technical aspects of preparing for meaningful use.
Skilled Support for Patients and Practices
Rheumatology nurse practitioners can expand capacity in busy rheumatology offices
“I am hard-pressed to sit down with a patient and not take extra time to explain a diagnosis or medication,” says Debra Bancroft Rizzo, MSN, FNP-C. Rizzo, who’s been an NP with the Rheumatic Disease Center in Glendale, Wis., for more than 15 years, is voicing one way her practice can enhance the total patient care experience.1 But educating patients about disease management is only one facet of what nurse practitioners (NPs) bring to the rheumatology practice, she notes. “We...
Translational Rheumatology
Changes to the NIH CTSA program may bring more support to bench-to-bedside research
"Translational research” has become the new buzzword in science. Increasingly, an important goal of research is a “bench-to-bedside” approach that rapidly progresses from fundamental laboratory studies to patient treatment. Translational science is gaining increasing prominence within the National Institutes of Health (NIH) as well. Since 2006, the NIH has funded translational research centers throughout the United States--the Clinical and Translational Science Awards (CTSA)...
Rheumatology Etymology
Defining some common words in the world of the rheumatologist
The medical world is full of words with long histories and multiple meanings. Here are a few commonly used in the field of rheumatology with their definitions and where they came from.
A Meeting of the Minds for RA Research
REF investigators gather to share research progress and trade advice
MIAMI--Grant recipients of the Within Our Reach: Finding a Cure for Rheumatoid Arthritis (RA) campaign--the ACR Research and Education Foundation’s (REF’s) $30-million research effort--traveled to South Florida recently to update each other on their projects. Perhaps just as important, they came to listen. The lively discussions included suggestions for refining projects and ideas for teaming up with other researchers.
Medical Education Goes Global
Rheumatology plays a role in med schools’ growing international partnerships
As medical schools consider ways to expand, one clear trend has emerged--international collaboration.
Put It in Writing
Hiring a physician extender involves more than a handshake
Physician extenders, commonly referred to as mid-level providers or practitioners, often offer financial profitability for the practice as well as efficiency, improved quality of care, enhanced flexibility for physicians and greater patient satisfaction. When you hire an extender, it’s important to go beyond a handshake and clearly define the terms of the relationship in a contract. Below are some of the key issues that should be addressed in a mid-level provider’s employment agreement.
Global Perspective
Healthcare policy varies by country, but U.S. lags in key areas
We’ve all heard the stereotypes: Other countries have socialized medicine, rationed care, endless lines, and little incentive for innovation. OK, there might be a grain of truth to the wait times. But healthcare in other developed nations is surprisingly varied in its mix of public and private providers, and it yields high-quality outcomes for a far better price than in the U.S. And yes, international innovation is alive and well.
Detecting Synovitis in Children
Ultrasound has potential to compliment physical examination in JIA patients
Early identification and treatment of active juvenile idiopathic inflammatory arthritis (JIA) may prevent long-term joint damage and disability, according to researchers from Montefiore Medical Center, Albert Einstein College of Medicine in the Bronx, New York. The team has shown that sonography with power Doppler may be effective in detecting subclinical inflammation in children with JIA and is complementary to physical examination.
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From the College
Don't Miss the Business of Rheumatology in Chicago
During the past 50 years, private practitioners have witnessed many substantial changes to the U.S. healthcare system and have been pressured to change the way they practice medicine.
Health Professionals Bound for Chicago
The 2011 ACR/ARHP Annual Meeting program offers a plethora of opportunities for health professionals to gain insight into emerging concepts in the diagnosis and treatment of rheumatologic disorders as well as improving quality of life in affected patients.
Journey from Early Career Grant Recipient to Preceptor
Elaine Husni, MD, MPH, knew from an early age that she wanted to be a doctor. Along the way, she relied on the support of mentors and the ACR Research and Education Foundation Awards and Grants program to help establish her career in rheumatology, eventually landing her in her current role as the department vice chair for the Arthritis and Musculoskeletal Center at the Cleveland Clinic.
Pain Management for the Person with RA: An Occupational Therapist’s Perspective
RA is a chronic disease that people must learn to live with for their lifetime. Occupational therapists (OTs) play a pivotal role in assisting patients with RA with functioning in the face of a disease that causes limitations and deformities.
Speak Up This Summer
Congress continues to make health policy decisions that directly affect you and your patients. It is critical that rheumatology professionals speak up about patient access to quality care, physician payment reform, research funding, and the multitude of concerns you and your colleagues face every day. Congress is on summer recess August 8–September 5, so now is the perfect time to reach out to your legislators and educate them on issues affecting the rheumatology community.
Coding Corner Question
August's Coding Challenge
A 33-year-old obese female patient with rheumatoid arthritis returns to the office for a follow-up visit. She is currently on sulindac, methotrexate, and folic acid. The patient’s methotrexate dose was increased at her last visit two months ago. She reports that her arthritis is doing well, except for her knees, which have been very swollen and stiff for the past two weeks. She denies fevers and reports that she has had epigastric pain for the past three weeks, which has progressively worsened and...
Coding Corner Asnwer
August's Coding Answers
Hire the Best Job Applicants Based on the Number Rating They Give Themselves
Psychologists say healthy self-esteem and work ethics are inextricably linked. Whether children are nurtured by circumstances and people who supported their self-esteem or damaged by those that don’t, the way in which they come to perceive themselves plays a big part in how they interact with others throughout their lives.
Practice Page
Government Exclusion Program : Can It Affect Your Practice?
The Office of Inspector General (OIG) is tasked with monitoring the federal agencies that are governed by the Department of Health and Human Services (HHS). It is responsible for audits, evaluations, investigations, and compliance in an effort to fight fraud and abuse of all government programs.
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Departments
Rheum with a View
Panush’s perspectives on selections from the literature
Could cell phones cause cancer heart disease, or even arthritis?
Essential Evidence Plus
Tools and Alerts for Clinicians Who Deliver First-Contact Care
Annual Vitamin D Supplementation Does Not Improve Mental Well-Being; Asking about Suicide Doesn’t Trigger Suicidal Ideation; Steroid Injections for Trochanteric Pain; Manipulation or Mobilization for Neck Pain; Opioids for Chronic Noncancer Pain; Behavioral Treatments for Chronic Low Back Pain; PECARN and CHALICE Best Rules in Children with Head Injuries; Iloprost and Cisaprost for Raynaud’s Phenomenon in Progressive Systemic Sclerosis; Therapeutic Ultrasound for Osteoarthritis of the Knee;...
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Columns
It’s A Small World after All
Advancing rheumatology throughout the world
The world is getting smaller, and to advance rheumatology, collaboration from rheumatology health professionals and organizations worldwide is required. Last month, "From the College" featured an article, "ACR Members Help Educate Rheumatologists Around the World."1 In light of that article and the importance of strengthening relationships throughout the rheumatology world, I am taking the opportunity to provide an update on the other rheumatology leagues and how through collaboration...
Past Secrets for the Future of Lupus
A stretch-limo ride with academic rheumatologists leads to reflection
In early spring this year, as daffodils erupted throughout Durham, N.C., and tears streamed after basketball defeats, I had the good fortune of spending an hour in enjoyable conversation with a group of academic rheumatologists. We were on our way to the airport after a stimulating and challenging meeting on lupus. Instead of one of those bumpy and creaky 20-seater buses, we were in back of a stretch limo, a Lincoln Navigator supreme, a vehicle ideal for parties and proms, an extravaganza of sheet metal...
An Identity Crisis for RA
A few suggestions to bring rheumatic disease the recognition and respect it deserves
Despite the numerous advances in treating rheumatic diseases over the past few decades, a major communication gap still exists in the community regarding the complexity and gravity of rheumatic diseases. The reality is that, in spite of the well-intended efforts of the ACR and the Arthritis Foundation (AF), the average lay individual still has only a limited concept of what systemic, inflammatory arthritis is all about.
