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Clinical Thought Process for Proper Medical Decision Making, Part 2

From the College  |  September 19, 2017

In Part 1 of this series, we covered the vital role of medical decision making in determining the final level to bill for a patient encounter. Medical decision making is the key component in coding because it reflects the intensity of the provider’s cognitive labor. This implies that there’s an unseen component involved in the…

TNF Inhibitor Drug Tapering Successful in Some Patients with RA

Thomas R. Collins  |  September 19, 2017

MADRID—Scores on the Health Assessment Questionnaire for Rheumatoid Arthritis (HAQ) and C-reactive protein (CRP) levels were independent predictors of whether patients could be tapered successfully from a TNF inhibitor after having reached remission of their RA, according to findings presented in a session at the Annual European Congress of Rheumatology. Researchers also developed a composite…

Whole-Body MRI, Ultrasound Imaging May Aid in Early Rheumatic Disease Diagnosis, Treatment

Thomas R. Collins  |  September 19, 2017

MADRID—Researchers say that whole-body MRI could yield an earlier diagnosis of spondyloarthropathy (SpA) in patients with early inflammatory joint symptoms, according to findings presented in a poster session at the Annual European Congress of Rheumatology (EULAR). The approach could lead to earlier treatment and better outcomes, they say. Investigators at the University of Leeds recruited…

Rheumatoid Arthritis Treatments Show Mixed Results

Thomas R. Collins  |  September 19, 2017

MADRID—The anti-IL6 “nanobody,” vobarilizumab, produced mixed results when used with methotrexate (MTX) and compared with MTX and placebo, according to results of a 24-week, double-blind Phase 2b study of patients with rheumatoid arthritis (RA), which were presented in an abstract session at the Annual European Congress of Rheumatology (EULAR). The drug missed its primary endpoint…

Effectiveness of Tofacitinib with Methotrexate, Adalimumab Therapy Evaluated in Patients with RA

Thomas R. Collins  |  September 19, 2017

MADRID—Tofacitinib (a JAK inhibitor) used with methotrexate (MTX) is not inferior to adalimumab (a TNF inhibitor) in rheumatoid arthritis (RA) patients who’ve had an inadequate response to MTX alone, according to results of a Phase 3B/4 trial presented in a session at the Annual European Congress of Rheumatology (EULAR). The findings came in a one-year…

Skype-Based Biopsychosocial Treatments Help Save Physical Therapy Patients Time, Trouble

Elizabeth Hofheinz, MPH, MEd  |  September 19, 2017

It’s a bit ironic that when injured people are in pain—and their mobility is reduced—they are often expected to travel to a physical therapy clinic. For millions of people, such trips are a burden. In Australia, however, some patients are “letting movement come to them.” Novel research from The University of Melbourne shows that taking…

Treat-to-Target Strategy Evaluated for Fibromyalgia Care

Susan Bernstein  |  September 19, 2017

Treat-to-target is a widely used approach for rheumatoid arthritis, in which rheumatologists prescribe treatments to reach established benchmarks of disease activity.1 Is it time for a similar approach for fibro­myalgia treatment, even though its pathogenesis, disease-activity measures and treatment algorithms are less well understood? Three fibromyalgia researchers present their case in a new paper, “Treat-to-Target…

A CT scan of the chest showing multifocal ground-glass opacities, representative of hemorrhage, with numerous nodular interstitial opacities primarily within a peribronchovascular distribution.

Hemoptysis in a Young Indian Male

Payam Pourhassani, DO, MSc, Sneha Patel, MD, & Arundathi Jayatilleke, MD  |  September 19, 2017

A 22-year-old Indian male presented to the emergency department with hemoptysis. A month prior, he had presented to an urgent care center complaining of cough with occasional episodes of blood-tinged sputum in the morning. He was diagnosed with community-acquired pneumonia based on a chest X-ray without laboratory testing and was prescribed levofloxacin. A few days…

FDA Approves Lesinurad + Allopurinol

Michele B. Kaufman, PharmD, BCGP  |  September 19, 2017

Duzallo, a combination of lesinurad and allopurinol, was approved by the FDA in August to treat hyperuricemia associated with gout…

Fellows’ Forum Case Report: Progressive Multifocal Leukoencephalopathy and RA

Eugene Jalbert, DO, MBA, Priyanka Murali, DO, Rakhee Shah, DO, Robert DiGiovanni, DO, FACOI, FACR, & Rubaiya Mallay, DO, FACOI, FACR  |  September 18, 2017

Rheumatoid arthritis (RA) is a systemic autoimmune disease associated with erosive destruction of diarthrodial joints. Patients who are seropositive are more prone to developing extra-articular manifestations, such as rheumatoid lung, rheumatoid nodules and others. With the development of disease-modifying anti-rheumatic drugs (DMARDs), the incidence and severity of these extra-articular manifestations has declined. Below, we describe…

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