Ultrasound may provide unique insights into the effects of immune checkpoint inhibitors on the human body beyond the immune system. Research suggests synovitis and inflammatory tendon involvement are commonly seen in patients with immune checkpoint inhibitor-induced inflammatory arthritis.... [Read More]
For most rheumatologists, the key elements of the physical exam—inspection, palpation, percussion and auscultation—have long been second nature, but a fifth modality has grown in importance with respect to making the correct diagnosis: ultrasound. From evaluating for Doppler signal and additional findings indicative of synovitis to identifying bony erosions, chondrocalcinosis, tophi and other articular and… [Read More]
A 65-year-old woman was referred by an orthopedist to a rheumatologist for left knee pain. Previously, in 2014, she underwent left total knee arthroplasty (TKA) for severe osteoarthritis in a different institution. Following the procedure, she experienced severe chronic anterolateral knee pain at rest, exacerbated by walking. Because she was rendered wheelchair bound and required… [Read More]
ATLANTA—Point-of-care ultrasound education mainly has occurred at the undergraduate level at U.S. medical schools, but rheumatology fellowship training programs are rapidly catching up and integrating it into their curricula, according to two program directors who reviewed the state of rheumatology ultrasound education, including potential barriers to its implementation, on Nov. 12 at the 2019 ACR/ARP… [Read More]
NEW YORK (Reuters Health)—Ultrasound guidance does not improve the effectiveness of treat-to-target therapy in rheumatoid arthritis (RA), new findings confirm. “Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy,” Dr. Ulf Sundin of Diakonhjemmet Hospital, Oslo, and colleagues write in Rheumatology…. [Read More]
A 56-year-old automobile mechanic was referred to our rheumatology service by his orthopedist to evaluate left posterior knee pain and swelling that had been present for three months. The patient had undergone bilateral total knee arthroplasties (TKAs) for sports-related osteoarthritis three years before. In addition to the knee pain, the patient described several years of… [Read More]
Take the challenge. Answer: No, if billed as incident-to for the NP. Note: The patient’s current insurance carrier is Blue Cross Blue Shield of Massachusetts (BCBS of MA). Under BCBS of MA, nurse practitioners and nurse practitioner primary care providers are not allowed to perform or interpret radiology services. Therefore, the physician would have to… [Read More]
A 32-year-old male patient with rheumatoid arthritis affecting multiple joints without rheumatoid factor returns to the office for a follow-up visit with the nurse practitioner (NP). The patient states his overall pain has improved since his previous visit, although he rates the severity of his right shoulder and right wrist pain at a 5 on… [Read More]
I have worked as an advanced practice provider (APP) in pediatric rheumatology for nearly 16 years. My collaborating physicians have allowed me to function to the full extent of my scope of practice while allowing me to develop professionally within the subspecialty. My latest endeavor has been learning how to perform musculoskeletal ultrasound (MSUS) and… [Read More]
Presentation A 30-year-old woman presented to her rheumatologist for left foot pain of three weeks’ duration. She was followed for systemic lupus erythematosus manifesting in arthritis and hemolytic anemia, as well as anti-nuclear antibody and Smith antibody positivity, and was treated with hydroxychloroquine and prednisone in the 2.5–10 mg per day range. She was symptom… [Read More]