From: The Rheumatologist, November 2011
For further reading
Increased sensitivity to apoptosis induced by methotrexate is mediated by jun N-terminal kinase; Reversal of the antiinflammatory effects of methotrexate by the nonselective adenosine receptor antagonists theophylline and caffeine. Evidence that the antiinflammatory effects of methotrexate are mediated via multiple adenosine receptors in rat adjuvant arthritis; A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent-onset rheumatoid arthritis; Relationship between...
Methotrexate and its mechanism of action
For almost 30 years, low-dose methotrexate has been the therapy for rheumatoid arthritis (RA) to which every other therapy is compared. Indeed, methotrexate forms the base upon which therapy for RA is built; even when the patient does not achieve a sufficient therapeutic effect from methotrexate, new agents are added to, rather than substituted for, this agent. It is now clear from registration studies on the treatment of early RA that methotrexate is nearly as effective as biological agents and that the...
A voyage to (our inner) Lilliput
Not even the most solitary of all human beings is really ever alone. Indeed, we always have company, with the numerically greatest number of life companions small and invisible, and residing within inside us who, like Gulliver, are genuine giants in comparison. From the very moment we are born, an astounding, complex, and dynamic consortium of microorganisms occupies our body cavities (skin, airways, genitourinary, and gastrointestinal tracts) and coexists with us harmoniously as long as we breathe. This...
Medical schools tap philanthropic organizatinos and the VA for research dollars
Potentially large cuts in National Institutes of Health (NIH) funding are driving a search for alternative sources of research and training dollars, intensifying the need for near perfection in grant applications, and may be driving some young physician scientists away from careers in research.
As medical research expands to the global population, will trial results sill apply to U.S. populations?
The conduct of clinical trials for U.S. Food and Drug Administration (FDA) drug approvals—whether they take place in an academic medical centers or private practices—is no longer the exclusive realm of the United States. A large percentage of trials today take place outside North America, with increasing numbers in developing countries.
MedPAC recommends deep cuts to physician payments
Rheumatologists and other physicians are facing yet another potential cut to Medicare reimbursement rates on January 1, 2012: an unimaginable 29.5% across-the-board cut because of the sustainable growth rate (SGR) formula that currently determines reimbursements. Also, MedPAC has recommended that Congress freeze reimbursement rates for a small group of primary-care physicians, and cut all other reimbursements, including those for rheumatologists, by 5.9% each year for three years, followed by a freeze in...
A fair wage and choice of practice setting are areas of concern
Rheumatologists in the United States earn $150,000–$250,000 per year, with an overall median salary of $173,000, according to the first-ever 2011 Physicians Compensation Report by Medscape, an Internet provider of medical information for physicians and consumers. Compensation remained steady in 2010, the survey year, compared with 2009.
From the College
As reported last month (“Rheumatologists Struggle with Drug Shortages,” October 2011, p. 51), a bill (S. 296) proposed in the U.S. Senate would require drug manufacturers to notify the U.S. Food and Drug Administration (FDA) of factors that might lead to a drug shortage.
Afton L. Hassett, PsyD
The extent and experience of pain is influenced by affective, behavioral, and cognitive processes. Thus, there are numerous factors to consider in pain management; however, the role of sleep may be one of the most important. There is good evidence that sleep, pain, and depression form a tightly interconnected triad where changes in one of the three can impact the other two. For example, disturbed sleep can result in increased pain and contribute to changes in mood, while persistent pain can contribute to...
Bringing calm and organization to chaos: This is what led Greg Dennis, MD, to pursue a career in rheumatology. Dr. Dennis who, at the time, was an internal medicine resident at Fitzsimons Army Medical Center in Aurora, Colo., was seeking a subspecialty that would allow him to pursue immunology in a clinical or laboratory setting. What he realized during his residency was that rheumatology was a mystery to many physicians.
The ACR’s annual Advocates for Arthritis conference, September 19–20, brought more than 120 rheumatologists, rheumatology health professionals, and patient advocates to our nation’s capital. Attendees, representing 37 states, met with more than 175 congressional offices, sharing their stories of access to care, treatment, and the importance of research.
Join the ACR as rheumatologists from across the country gather in Snowmass, Colo., for six days of exceptional educational content and opportunities to interact with peers and expert faculty at the ACR’s Winter Rheumatology Symposium. Continuing a tradition more than three decades long, the meeting will offer attendees upward of twenty sessions.
When treating a patient that lives in a skilled nursing facility (SNF), it is important to understand the coding and billing guidelines of consolidated billing. That is because certain services must be consolidated and submitted by the SNF using its Medicare provider number, and not submitted by you, the physician, unless they are one of the excluded services, which will be further discussed below.
Skilled nursing facility patients
A 53-year-old obese female Medicare patient with rheumatoid arthritis returns to the office for a follow-up visit. She currently resides in a skilled nursing facility. She is 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. She denies fever and reports that she experiencing epigastric pain for the...
Skilled nursing facility patients
Compliance programs are an effort by the government to maintain integrity in the healthcare system. These programs target activities causing improper payment to determine their root cause: Was it a mistake or error, was it inefficiency or waste of resources, is the provider bending the rules or abusing the system, or was it intentional deception or fraud? There are also laws dictating the compliance culture within practices and institutions; for example, red-flag rules, antikickback statute, and stark law,...
Information on new approvals and medication safety
According to a meta-analysis published in JAMA, the anti–interleukin (IL)-12/23 agents ustekinumab and briakinumab and the anti–tumor necrosis-alpha (TNF-α) agents adalimumab, etanercept, and infliximab do not increase the rate of major adverse cardiovascular events (MACE).1 Randomized, placebo-controlled, double-blind, monotherapy studies in patients with chronic plaque psoriasis were evaluated. More than 10,000 patients met the inclusion criteria in 22 randomized controlled trials. The...
The many accomplishments of the past year set the stage for a bright, busy future
It’s hard to believe that 11 months ago I was addressing you for the first time as president of the ACR and highlighting my priorities for the year, guided by the ACR strategic plan. As I end my presidency, I want to spotlight a selection of our accomplishments, while recognizing the future challenges that remain for our profession and the ACR. These projects show the ACR’s ongoing commitment to address the concerns of the profession, our membership of rheumatologists and rheumatology health...
Voting for your future
In the 1992 election, James Carville advanced an idea for President Bill Clinton’s campaign that has had enduring significance, with a statement that has entered the modern lexicon of politics—not to say almost every other realm of human activity. When asked what was on the voters’ mind, Carville said, “It’s the economy, stupid.”
Why rheumatologists should consider making this the uniform of choice
In the last year, I’ve taken to wearing theatre scrubs at work instead of my usual suit, shirt, and tie attire. This was initially because I started cycling to work and it was simply too much hassle to put clean shirts in my backpack or drop clean clothes at the office over the weekend. After a few days of wearing them in my clinic, I haven’t gone back.
Why I sometimes read poetry instead of medicine—and why you should, too
I came to learn that reading poetry and reflecting about humanities made me a better person and better doctor. When I introduced medical humanities to faculty and residents on bedside rounds, they, too, became measurably better physicians and probably provided demonstrably better care.