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Figure 1. A nasal biopsy shows intimal infiltration of the small blood vessels (black arrow).

Case Illustrates the Difficulty Diagnosing Granulomatosis with Polyangiitis

Diana Girnita, MD, PhD, & Vishnuteja Devalla, MD  |  June 21, 2018

Granulomatosis with polyangiitis (GPA) was first described in the British Medical Journal in 1897 by Scottish otolaryngologist Peter McBride.1 GPA is a relatively rare, systemic necrotizing vasculitis that can make diagnosis challenging. The incidence has been estimated anywhere between two and 12 cases per million.2 GPA mainly affects adults between the ages of 45 and…

Looking for Links Between Rheumatoid Arthritis & Gut Bacteria, Mutations

Renée Bacher  |  June 21, 2018

Patients with a specific genetic predisposition for rheumatoid arthritis (RA) may want to take precautions when consuming certain types of meat, dairy and produce grown with cow manure, according to a new study out of the University of Central Florida (UCF) in Orlando. The study, which assessed 100 RA patients, published in the journal Frontiers…

Researchers Seek to Predict & Prevent Rheumatoid Arthritis

Jeffrey A. Sparks, MD, MMSc, & Kevin D. Deane, MD, PhD  |  June 21, 2018

Preventing adverse outcomes in individuals who have rheumatic diseases is a daily goal for rheumatologists. For example, rheumatologists prescribe medications and perform screening to prevent erosions in rheumatoid arthritis (RA), renal failure in systemic lupus erythematosus and flares across all diseases. Many of these actions are classified as secondary or tertiary prevention, because individuals have…

Running a Big Rheumatology Practice Requires Learning, Communication

Kelly Tyrrell  |  June 21, 2018

If you had asked Ray Waldrup in 1981 what he would be doing in 2018, serving as the CEO of the largest rheumatology practice in the U.S. would probably not have been his first guess. Back then, as a young college student in Georgia, Mr. Waldrup took a job at a national jewelry retailer and…

Dr. Ellen M. Gravallese In the Spotlight

Gretchen Henkel  |  June 21, 2018

Robert Finberg, MD, chair of medicine at the University of Massachusetts (UMass) in Worcester, describes Ellen M. Gravallese, MD, as one of a dying breed: a quadruple-threat physician who excels in basic science research, clinical care, teaching and administration. Dr. Gravallese holds the Myles J. McDonough Chair in Rheuma­tology, is professor of medicine and serves…

The ACR’s Congressional Advocacy Produces Results

David I. Daikh, MD, PhD  |  June 21, 2018

The underlying tenet of the ACR’s advocacy efforts is that we cannot effect change for our profession and our patients unless we take our issues directly to decision makers. As I write this column, I am highly encouraged by the progress we have made so far this year in the advocacy realm. At the same…

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Prescribing Hope: The Placebo Effect Endures

Philip Seo, MD, MHS  |  June 21, 2018

“Wait. I can explain.” One could imagine this phrase coming up under many conditions in daily life. When I first became a physician, however, I would never have expected to use this phrase in my clinic. In medical school, I was taught the importance of dialogue in establishing a relationship with a patient. Statistics indicate…

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When & How to Talk to Your Patients About Their Gender & Sex

Susan Bernstein  |  June 21, 2018

How do you ask a new patient about sex and gender—or know which pronoun to use? Keep the conversation straightforward and respectful to put everyone at ease, says Morgan Orndorff, a transgender man who works as an administrator at a major academic medical center. “Everyone is a little different in terms of their sensitivity level”…

Rheumatology Coding Corner Answer: Medical Chart Review of an Infliximab Infusion

From the College  |  June 21, 2018

Take the challenge. CPT codes: 96413, 96415, 96375, J1745x30, J1200x1 Diagnosis ICD-10: M05.79 With the total infusion time of two hours and 13 minutes, CPT code 96413 is used to code for the first hour of the infusion and 96415 for the additional hour. The infusion would have to be 31 minutes into the next…

Coding Corner Question: Medical Chart Review of an Infliximab Infusion

From the College  |  June 21, 2018

A 73-year-old female established patient with rheuma­toid arthritis affecting multiple joints and with positive rheumatoid factor returns to the office for an infliximab infusion. She denies any fevers, cough, dyspnea or concurrent illness. She has joint pain of 6 on the pain scale. She is on an NSAID, weekly methotrexate subcutaneous injections, folic acid and…

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