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News: Rheum to Learn
More and more rheumatologists are looking to expand their practices by adding a nurse practitioner (NP) or physician assistant (PA) to help with increasing patient loads. While an additional person can certainly enhance practice operations, it can be difficult to find an ancillary health professional trained in rheumatology, and daunting for a small practice to consider training an NP or PA in the subspecialty. On the other hand, a skilled NP or PA can benefit the practice overall and help provide better...
Viewpoints: Letters to the Editor
In May’s “Rheuminations” column, “To Document or to Doctor?” (p.6), Dr. Pisetsky speculated on whether paperwork burdens are detracting from patient care. Several readers wrote in with their views on the “document-or-doctor” dilemma. We’ve published a selection of those responses here, and we want to thank everyone who wrote in. Keep those letters coming!—The Rheumatologist’s Editors
From the College: Embracing Techmanity
Will increasing technology in the exam room have a dehumanizing effect on the patient physician relationship? Maybe not.
Certainly, this is wise advice, especially in an era when reimbursement depends on the demonstration that a host of items have been performed in the clinical setting: history and physical, review of systems, review of records, complex decision making, and so on. In the realm of education, documentation also abounds and includes needs assessments, written goals and objectives, and disclosure statements, among others.
Columns: Does Secondary Gain Exist?
In this and two subsequent columns, I will discuss the concept of secondary gain as it applies to disability. My goal is to revise a view I long embraced and, indeed, promulgated enthusiastically to students, house officers, and fellows. On many occasions in my teaching clinic, I stated that the concept of secondary gain in disability is misleading if not erroneous because what can be labeled as gain in reality represents loss. Sometimes I was even more dogmatic and said that secondary gain does not exist.
People with myositis may have significant functional limitations and disability despite appropriate pharmacologic treatment to reduce inflammatory damage to their muscles. The impairments associated with myositis often result in a loss of independent ambulation, difficulty rising from a chair, an inability to negotiate stairs, and diminished health-related quality of life. Therefore, meaningful outcomes measures and effective therapeutic exercise remain important in the medical management of the disease.
Features: Myositis Mysteries
A 26-year-old female was referred to the rheumatology service two years after the insidious onset of “walking funny” that progressed to significant proximal muscle weakness over a 10-month period. Early in the course of her illness, her creatine kinase (CK) was 4,000. Subsequent muscle biopsy revealed muscle fiber degeneration and regeneration in addition to numerous phagocytic cells. She was diagnosed with polymyositis but, despite treatment with high-dose corticosteroids, methotrexate (MTX),...
From the College: Metabolic Myopathies
Metabolic myopathies are diseases caused by rare genetic defects that interfere with the energy-generating processes in skeletal muscles. A metabolic myopathy is caused when not enough of a particular enzyme is present to cause the necessary reactions. The name of each metabolic myopathy is based on which pathway has the deficient enzyme. For example, diseases brought on by a defect in sugar metabolism are called glycogen storage diseases. Lipid storage diseases are due to abnormal fat processing. Finally,...