Chronic insomnia is a common complaint for patients with rheumatic diseases and conditions. In fact, sleep disturbances are among the most common symptoms of both fibromyalgia and rheumatoid arthritis (RA), with more than 50% of chronic pain patients reporting sleep disturbances. Pain combined with insomnia can lead to a vicious cycle, says Ruth Gentry, PhD,…
View the question. Findings/Diagnosis The radiographs demonstrate diffuse sheetlike and tumefactive calcifications throughout the subcutaneous tissues, muscle and fascia of the pelvis and right hand. The underlying bones and joint spaces appear normal. The differential diagnosis for soft tissue calcification is extensive and includes metabolic disturbances (particularly of calcium and phosphate), trauma (e.g., injection sites,…
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History These radiographic images are of a 25-year-old woman with a known…
Researchers from California and Texas have identified a new genetic syndrome that is characterized by systemic autoimmune disease of the lung and joints. The syndrome is driven by a genetic variant of a vesicular transport protein and is the first documented association between intracellular transport and autoimmunity. Levi B. Watkin, PhD, postdoctoral fellow at Baylor…
A 65-year-old established female patient returns to the office for a follow-up visit for her diagnosis of fibromyalgia. She complains of pain, stiffness and swelling in her left hand, elbow and neck that is persistent since her last visit. The pain is considerably worse in the morning. She denies any fevers, cough or dyspnea. The…
Take the challenge. CPT codes: 99213-25, 20553, 73120/LT Diagnosis: ICD-9 7291 ICD-10 M79.7 Coding for trigger-point injections continues to create a lot of confusion on proper coding guidelines. Keep in mind, two CPT4 codes can be used for trigger-point procedures: 20552—Injection(s); single or multiple trigger point(s), one or two muscle(s); and 20553—Single or multiple trigger…
For patients living with a chronic disease, such as rheumatoid arthritis or osteoarthritis, learning to manage and cope with the myriad adverse symptoms that accompany these diseases is key to improving quality of life and helping reduce the cost burden of these illnesses on the healthcare system. One important way rheumatologists can help is by…
A report from the Institute of Medicine that gives new diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and recommends a new name for the disorder received mixed reviews from rheumatologists and other physicians.1 “Diagnosing ME/CFS often is a challenge … the new diagnostic criteria will make it easier for clinicians to recognize and accurately…
Glucocorticoids: The Debate Continues Déjà vu … In past decades, rheumatologists have seen, heard, practiced and taught much of what has been argued in the “ongoing debate” on the use of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA).1 It is heartening to note that eminent professors have stuck to their premise all these…
Sleep disturbance is an important medical problem, requiring intervention, not simply to reduce latency to its onset, but to ensure achievement of the depth of sleep that has been documented to restore homeostasis and prevent the falls that are responsible for so much morbidity and mortality.1 Sleep disturbance is present in 50% of people over…