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From: The Rheumatologist, October 2011


Pain in Rheumatoid Arthritis

Out from the shadow of inflammation

A 43-year-old woman presented to a rheumatologist for evaluation with a six-week history of ar­thralgias in the wrist, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints. On examination, MCP joints were tender to palpation, and the left wrist and the right third and fourth PIPs were swollen. Because of a positive rheumatoid factor and anticyclic citrullinated peptide antibody test, the patient was diagnosed with rheumatoid arthritis (RA) and started on methotrexate and, subsequently,...

Patients Add Power to Research Initiatives

A look at how OMERACT involves people with rheumatic disease in its studies

OMERACT (Outcome Measures in Rheumatology) has provided a great stimulus to think about the effects of rheumatic diseases on patients and society, and the impact of their treatment.1 It all started in 1992, with the development of a core set of outcome measures for rheumatoid arthritis (RA). Officially, these measures are termed the World Health Organization and International League of Associations for Rheumatology core endpoints for symptom-modifying antirheumatic drugs in rheumatoid arthritis clinical...

Practices Plan for Coding Changes

Will you be ready for October 1, 2013?

It still seems to be a long way off—the changeover to the International Statistical Classification of Disease, 10th Revision (ICD-10) doesn’t become mandatory until October 1, 2013. But when you consider that practices need to look at computer systems, billing methods, and even patient welcome packets, that date is a lot closer than many think.

Chaos Control

Plan ahead to ensure your practice survives a disaster

Ten years have passed since the U.S. was attacked on September 11, 2001, and six since Hurricane Katrina slammed into the Gulf Coast. While disasters of this magnitude are rare, hundreds of smaller-scale disasters occur every year, including tornadoes, blizzards, fires, earthquakes, airline crashes, and chemical spills.

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A&R and AC&R Abstracts: Pain in RA

For further reading

The ACR preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity; Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia; Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis; Report of the ACR Pain Management Task Force; Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases; Evidence...

Space Traveling Mice Provide Insight into Osteoporosis

Researchers are using the unique, zero-gravity environment to develop therapies for the earthbound

Ten years from now, the final flight of the space shuttle Atlantis could very well have a footnote in the annals of bone density research.

Rheumatologists Struggle with Drug Shortages

While not yet at a ‘catastrophic’ level, shortages are becoming more common

In addition to seeing patients and managing their conditions, Edward Fudman, MD, a rheumatologist in Austin, Texas, has recently been doing a great deal of something else—rewriting a prescription he’s already written because of a drug shortage.

A Window into Health Disparities

Systemic lupus erythematosus offers a touchstone for the U.S. healthcare system--and how we care for vulnerable patients

It is well known that systemic lupus erythematosus (SLE) disproportionately affects women and members of racial and ethnic minorities, and that persons with SLE of lower socioeconomic status have poorer outcomes of disease and higher death rates. The combination of SLE’s increased prevalence among minorities and women and its complexity, which leads to a need to have access to a wide range of healthcare services, makes SLE an important case study of how people of a racial or ethnic minority or...

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From the College

Stage 2 of the EHR Incentive Program

Although reporting for Stage 1 of the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program began just this year, the rules, objectives, and measures for Stage 2 are already being established. Last June, the Office of the National Coordinator (ONC) for Health Information Technology (IT) presented CMS with its recommendations for Stage 2 of the CMS EHR Incentive Program which builds on the Stage 1 objectives supporting EHR utilization for data capture and sharing.

Chicago My Way: Anne-Marie Malfait, MD, PhD, Provides Insider Info

Chicago is a city with remarkable shopping opportunities, upscale and trendy neighborhood boutiques, galleries, and specialty shops. 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.

Empower Rheumatology Patients

Patient empowerment and education are important parts of rheumatology care.

REF: Looking at Recent Achievements and FInding Inspiration for the Future

As the term of my presidency at the ACR Research and Education Foundation (REF) comes to an end, it’s a good time to reflect on the past two years. While it’s important to recognize the REF’s milestones and major achievements—and I will do that in a moment—great work is being done every day by rheumatologists, healthcare professionals, and investigators. It is their goal to improve the treatment and care of people impacted by rheumatic disease, and it’s our mission to...

Researcher Looks at Link between Arthritis and Eye Disease

Holly Rosenzweig, PhD, has developed a novel investigative model that may better inform treatment of patients with ankylosing spondylitis (AS) who also develop uveitis.

REF Volunteer Brings Passion for Communicating to New Program

When the ACR REF recently sent out a call for volunteers for the newly created From the Field speakers’ bureau, Alan W. Friedman, MD, responded right away. “It’s exactly what I’ve been doing all along,” he says. “I want to bring my enthusiasm for the cause to other people.”

Coding Corner Question

October’s Coding Challenge Medically Unlikely Edits (MUE)

A 53-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 in her left knee, which has been very swollen and stiff for the past two weeks, and her right index finger, which has been swollen. She denied fevers and reports that she has had epigastric pain for the...

Coding Corner Answer

October's Coding Answer

MUEs and Muscular Ultrasound Guidance: An Unlikely Story

Medically Unlikely Edits (MUEs) were launched on January 1, 2007 by the Centers for Medicare and Medicaid Services (CMS) to reduce the paid claims error rate for Medicare Part B claims. The function of MUEs is to detect and deny unlikely CMS claims for a Medicare patient on a single, 24-hour date of service on a prepayment basis. This is achieved by limiting the frequency of services provided by a physician or medical supply company.

Practice Pearls

Evaluating Your Practice Space

Due to economics, you may be reluctant to add more space to your practice. Although the upfront costs are intimidating, additional space means increased capacity, which equals more income.

Practice Page

The importance of coding certification

Medical billers and coders are an inherent part of any health organization because they are responsible for managing and submitting insurance claim documents for reimbursement. It is no surprise that this job area has been observed as one of the fastest growing career choices in the healthcare industry by the U.S. Department of Labor.

Learn How the ACR is Advancing Rheumatology on Capitol Hill

While you are at the 2011 ACR/ARHP Annual Scientific Meeting learning about the latest advancements in rheumatologic care, stop by the Advocacy kiosk at the ACR Resource Center to discuss the latest developments in health policy. Currently, medicine is on the verge of great change with Congress discussing everything from physician payment reform to cuts to biomedical research and medical liability reform. The ACR advocates on behalf of the rheumatology profession and our patients and is actively pursuing...

Back Pain and the Role of the Physical Therapist

Back pain is a common occurrence, so much so that most adults will have at least one episode of back pain at some point in their lives. Fortunately, most of these episodes last only a few days and resolve if patients maintain normal activity levels, avoid the detrimental effects of too much bed rest, use over-the-counter pain relievers with caution, and seek the attention of a health professional if the pain or other symptoms persist or worsen over time.

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Feedback from Our Readers

A T2T Solution; Patients React to Rheumatology’s Identity Crisis

Rheum With a View

Panush’s perspectives on selections from the literature

This month we’re going to look at the literature through the lens of that childhood game of “animal, vegetable, or mineral” (having 20 questions to guess which), and some thoughts about relocating to Southern California (I’ve no idea what category that would belong to).

It's All About the Patient

Trailblazer Evelyn V. Hess combines science and patient care

We always knew she was going a thousand miles an hour,” recalls Kenneth Grant, MD, professor of medicine at Touro University in Nevada, of his former mentor Evelyn V. Hess, MD, distinguished professor emerita and founder and former chief of the division of immunology, allergy, and rheumatology at the University of Cincinnati Medical School. Adds Michael Luggen, MD, another former fellow of Dr. Hess and professor of clinical medicine in the Division at the University of Cincinnati: “She had...

Essential Evidence Plus

Tools and Alerts for Clinicians Who Deliver First-Contact Care

Brief Behavioral Therapy Diminishes Insomnia in the Elderly; Instruments for Assessing Medical Decision-Making Capacity; Vertebroplasty No More Effective than Sham Treatment for Compression Fracture; Following STOPP Criteria Can Decrease Adverse Drug Effects in Older Patients; Probiotic Decreases IBS Symptoms

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Strike While the Iron Is Hot

How The ACR Lupus Initiative is advancing rheumatology

Last December, I promised that in 2011, the ACR would focus on promoting the needs of the profession, our membership, and especially our patients. I encouraged us to “stay strategic” in taking advantage of opportunities as they appeared in these rapidly changing times. In subsequent columns, I suggested that, to advance rheumatology, we should be proactive in meeting the needs of our profession and our patients.


Colorful characters and old friends meet in London

Last month, I wrote about braving the threatening wrath of the Icelandic volcano Grímsvötn in order to attend the 2011 European League Against Rheumatism (EULAR) Congress in London. Fortunately, I arrived safely at Heathrow airport and made my way to the ExCel convention center. I want to now share with you some of my impressions from this year’s congress.

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