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From: The Rheumatologist, December 2010
Features
Macrophage Activation Syndrome
A review of diagnosis, treatment, and prognosis
In pediatric rheumatology, the term macrophage activation syndrome (MAS) refers to a condition caused by excessive activation and expansion of T lymphocytes and macrophagic histiocytes that exhibit hemophagocytic activity. Although the pathognomonic feature of MAS (i.e., histiocytes phagocytosing normal hematopoietic elements) is usually seen in bone marrow (see Figure 1, p. 23), such cells can infiltrate almost any organ in the body. The expansion of these cells also leads to a massive systemic...
Can Technology Help Solve Scleroderma Renal Crisis?
A case study in using the Internet to facilitate rare disease research
How does one study rare events in uncommon diseases? At a meeting of the Scleroderma Clinical Trial Consortium a few years ago, a heated debate broke out about the role of angiotensin-converting enzyme (ACE) inhibitors as prophylaxis for scleroderma renal crisis (SRC). Severe, uncontrolled hypertension and rapidly progressive renal failure characterize this syndrome. The onset of hypertension is abrupt and may be associated with retinal hemorrhages, retinal infarcts, and papilledema. Microangiopathic...
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News
ACR Honors Accomplishments in Rheumatology
Rheumatologists and health professionals recognized for their contributions to the field
At the 2010 ACR/ARHP Annual Scientific Meeting in Atlanta, the ACR and ARHP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education, and patient care. The Rheumatologist spoke with the winners about their individual contributions to advancing rheumatology. This month, we’ll meet the ACR award winners, and in a future issue, we’ll meet the ARHP winners.
Juvenile Fibromyalgia Emerges from Its Silence
It can be treated, say researchers—but only if diagnosed
Cognitive-behavioral therapy (CBT) can be highly effective for reducing disability and depressive symptoms in patients with juvenile fibromyalgia (JFM), according to recent research. But experts on the syndrome say that progress in treating JFM has been hindered by clinicians’ reluctance to diagnose it.
Immunizations and Autoimmune Disease
What is safe and what to avoid in this patient population
Rheumatologists are often asked about the safety and efficacy of various immunizations in adults with rheumatic diseases, but many have questions about which vaccines are safe to use in this population. Clifton Bingham III, MD, director of the Johns Hopkins Arthritis Center and associate professor of medicine at Johns Hopkins University in Baltimore, addressed these concerns during a presentation titled “Immunizations and Rheumatic Diseases: An Update” at the 2010 ACR/ARHP Annual Scientific...
Pain-Free Equals a Home Run
Integrated approach sets stage for rehabilitation following shoulder arthroplasty
Advances in shoulder arthroplasty have extended what surgeons can offer patients suffering from shoulder pain. Those advances have, in turn, driven refinements in rehabilitation protocols. In a session titled, “Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty: Surgery and Rehabilitation,” here at the 2010 ACR/ARHP Annual Scientific Meeting, an orthopedic shoulder specialist and a physical therapist partnered to discuss the integrated approach to shoulder repair and...
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From the College
Build a Solid Foundation for Patient Care: 2011 Professional Meetings
You’ve come to rely on the ACR for meeting your professional development needs. Along with the ACR/ARHP Annual Scientific Meeting, the College provides symposia and other courses designed especially for rheumatology health professionals.
New GIOP Guidelines Available
The ACR published new recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in the November issue of Arthritis Care & Research. These guidelines have been endorsed by the American Society for Bone and Mineral Research. They apply to adult patients receiving oral glucocorticoid therapy.
Naturally Occurring Antibodies May Lead to New RA Therapies
A study published in the Journal of Immunology indicates that naturally occurring antibodies in the human immune system have the capacity to suppress inflammatory responses throughout the body. These antibodies may provide researchers an opportunity to develop new therapies for rheumatoid arthritis (RA) and other inflammatory conditions using similar pathways.
Coding Corner Question
December’s Coding Challenge
A 54-year-old female with rheumatoid arthritis (RA) and osteoporosis (OP) returns to the rheumatology practice for a follow-up visit. She reports that the pain in her hands and feet is slightly worse than last visit. She has morning stiffness for one hour with increased fatigue and swelling in her fingers. She continues to have dry eyes and mouth. She denies fever, chills, cough, and shortness of breath, and she has no rashes.
Coding Corner Answer
December’s Coding Answer
2011 Legislative Outlook Important for Rheumatology
Next year is shaping up to be an important year for rheumatology on Capitol Hill. Issues that remain unresolved by the last Congress include concerns within the Affordable Care Act, the need for a stable Medicare system with fair physician reimbursement, funding for the pediatric subspecialty loan repayment program, and appropriate reimbursement for specialty care. Most congressional leaders, newly elected or re-elected, know very little about arthritis and other rheumatic diseases. That is why it is...
Audited by a Recovery Auditor Contractor—Now What?
The word audit seems to put fear into the hearts of many physician practices across the country—and it shouldn’t. If you are prepared for an audit, your practice will run more smoothly from both a financial and personnel standpoint.
Comprehensive Rheumatology Training
Are you looking for a better rheumatology-focused, on-the-job training program for a nurse practitioner, physician assistant, or other clinician? Do you and your colleagues want to continue building competence in the care of people with rheumatic disease? The Advanced Rheumatology Course may be just what you need.
PRACTICE PAGE: Improving Patient Flow
Two techniques you can use to improve patient flow are flow mapping and cycle-time measurement. Flow mapping requires practice staff to walk through the practice and take notes about what a patient experiences during a visit. This allows you to understand the flow from the patient’s point of view. Key things to record are experiences and impressions of the practice from start to finish, such as observations of customer service, right down to the paperwork and equipment used.
RHEUMATOLOGY PRACTICE PEARLS: Appealing an Audit
The appeals process for a Medicare or Recovery Audit Contractor audit is a multistep process with filing deadlines attached to each level.
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Departments
Rheum with a View
Panush’s perspectives on selections from the literature
I came across a couple of reports that have the potential to profoundly change our thinking and practice (if the work is confirmed, extended, and found applicable to human disease). They are worth noting.
"A Common Language for SPONDYLOARTHRITIS"
ASAS fills a niche, changes dogma with consensus approach
Fifteen years ago, a small group of academic rheumatologists began meeting to discuss a common clinical interest in ankylosing spondylitis (AS). Their work launched a dialogue that has had an enormous impact on the field of rheumatology—and on the lives of people with AS. A disease with little in the way of common measurement tools, AS soon gained center stage in rheumatology as treatment with tumor necrosis factor (TNF) inhibitors showed dramatic results for this previously intractable condition....
Essential Evidence Plus
Tools and Alerts for Clinicians Who Deliver First-Contact Care
NSAID = Glucosamine = Chondroitin = Placebo for Knee OA; ACL Reconstruction Not Necessary for Good Clinical Outcome; Glucosamine Ineffective for Treatment of Degenerative Lumbar Osteoarthritis; Single Intraarticular Hyaluronic Acid = Placebo in Hip DJD; Synovitis of the Hip; Perthes Disease; Slipped Capital Femoral Epiphysis; Ischiopubic Synchondrosis (van Neck Osteochondrosis); Strain-induced Osteochondroses of the Hip; Heparin + ASA Better Than ASA in Preventing Fetal Loss in Women with...
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Columns
Advancing Rheumatology on Many Fronts
Presidential priorities for the coming year
As I begin my presidential term, I would first like to thank each of you, colleagues and friends, for the honor of serving you during 2010–2011. I know that the upcoming year will bring many challenges and changes, especially related to new federal laws and regulations. You can rest assured that the ACR is committed to promoting the needs of the profession, our membership, and especially our patients during these rapidly changing times.
