SAN FRANCISCO—Penetrating the dense extracellular matrix of cartilage is a challenge for administering osteoarthritis drugs, but an answer might lie in the matrix itself—in particular, its electrical charge, researchers reported at the 2015 ACR/ARHP Annual Meeting. Electrical Affinity Investigators at the Massachusetts Institute of Technology have found—at least in vitro and in animals—that delivering drugs…
SAN FRANCISCO—To convey the plight of rheumatology patients in sub-Saharan Africa, Girish Mody, MD, head of rheumatology at the University of KwaZulu-Natal in South Africa and past president of the African League of Associations for Rheumatology, recounted a story during the 2015 ACR/ARHP Annual Meeting from the World Health Organization about a diabetes patient. The…
SAN FRANCISCO—A broadening of the medical community’s horizons in how pain is regarded and treated in older adults, including those with osteoarthritis and other rheumatic diseases, is sorely needed, a researcher said at the 2015 ACR/ARHP Annual Meeting. Incidence Studies show that a large percentage of older adults each year see physicians for such issues…
SAN FRANCISCO—The discovery of a promising new target for the treatment of osteoporosis has a beginning to the story that, when it comes to scientific breakthroughs, rings familiar: It started with a disappointment. Researchers in the lab of Laurie H. Glimcher, MD, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College—were in search…
Robert Thoburn, MD, finds discipline and the opportunity for continual learning in both rheumatology and karate, an activity he has pursued for decades. Karate Lessons “I was fortunate to have had the opportunity to learn karate and achieve a black belt,” Dr. Thoburn says. “I used my training journal and [did] extensive research to write a…
The boy who could not walk: S.L. is a previously healthy 10-year-old boy who has not walked for three months. Physical examination reveals swollen wrists, knees, ankles and several toes. There is reduced hip range of motion and flexion contractures of both knees. He can stand with assistance, but is unable to take a single…
On Nov. 19, 2015, the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) recommended granting marketing authorization for SB4, an etanercept biosimilar product that will be called Benepali.1 On Jan. 16, 2016, EMA granted marketing authorization in the European Union for Benepali to be used to treat rheumatoid arthritis (RA), psoriatic…
The human intestinal microbiota is home to more than 1,000 bacterial species, containing approximately 3 million genes, many of which code for functions that have the potential to affect human physiology.1 Smaller numbers of organisms are also present in the skin, upper gastrointestinal tract, female reproductive tract and the oro- and nasopharynx. As tools have…
There is no denying that the past few years have been a time of immense change in healthcare. Sweeping pieces of legislation have fundamentally altered the way we practice medicine. This is absolutely the case when it comes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, for short). MACRA is an enormous…
“That’s a great case. Why don’t we write it up?” It’s a question I’ve heard many times throughout medical school, residency and fellowship. It’s typically intended to be more of a politely worded request than a rhetorical question. We must acknowledge that the process of writing, editing and submitting a case report is onerous, but it…
Arthritis is the primary cause of disability among U.S. military veterans and the second most common reason for medical discharge from the U.S. Army. One in three veterans is diagnosed with arthritis, compared with one in five members of the general U.S. population. It is important to keep in mind that these statistics reflect only…
For keen students of American politics, the unending intrigue of the 2016 presidential race has been riveting. With an assemblage of aspiring candidates that, at its start, included a bevy of U.S. senators and former governors, a media-savvy real estate mogul, a renowned Hopkins neurosurgeon and an ophthalmologist, political junkies among us have feasted on…
When reporting E/M service levels, if time spent counseling and/or coordinating care dominates the session, which of the following is true? Total time must be documented Greater than 50% of the time must be for face-to-face counseling and/or coordinating care The extent of the counseling and/or coordinating care must be documented All of the above…
Dramatic advancements in research toward prevention and cure are at risk, as federal research funding for rheumatic diseases has declined by 40% over the past five years. With that, an alarming number of rheumatologists are preparing for retirement. To stop this worrying trend, a strategic plan for the next five years was developed to complement…
Take the challenge. 1. D: All of the above Rationale: Per CPT, if time spent counseling and/or coordinating care dominates the session, then total time must be documented; greater than 50% of the time must be for face-to-face counseling and/or coordinating care, and must be documented as such. Additionally, the extent of the counseling and/or…
Mindfulness is a mental state achieved by focusing one’s awareness on the present moment, while acknowledging and non-judgmentally accepting one’s feelings, thoughts and bodily sensations. Known in Sanskrit as smrti, meaning “to remember,” in Pali, the language of early Buddhist scriptures, it is recognized by the word sati (mindfulness).1 Derived from ancient meditative Buddhist disciplines,…
Since 2005, the ACR’s Committee on Research has been responsible for advancing the research goals of the organization and providing leadership in research and research training in rheumatology via the ACR’s Research Agenda. The ACR Research Agenda is designed to address critical areas of research in rheumatic diseases, including the need for new technology, new…
The American Medical Association consists of two key groups: 1) the Relative Value Scale Update Committee (RUC), which oversees the annual updates to the physician work relative values, and 2) the Current Procedural Terminology (CPT) Editorial Panel, which assigns new or revised codes in the CPT book. The CPT Process Current Procedural Terminology (CPT) was…
The microbiome comprises diverse microbial flora, including bacteria, viruses and fungi, that live on mucosal surfaces, predominantly the skin and digestive tract. Microbes evolved billions of years prior to the development of modern Homo sapiens 200,000 years ago; we have always existed with their ubiquitous presence. Despite this, the first microbe was not visualized until…
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 A 49-year-old woman presents with one year of chronic left ankle…
After years of speculation about potential cost savings and debates on safety, biosimilars are about to step onto the stage of rheumatic disease treatment. On Feb. 9, the Arthritis Advisory Committee of the U.S. Food and Drug Administration (FDA) met in Washington, D.C., and recommended the approval of CT-P13, a proposed biosimilar to infliximab (Remicade),…
Radiographic imaging showed circumferential soft tissue swelling of the ankle with a soft-tissue density seen in the tibiotalar and posterior subtalar joints, as well as a large, lobulated effusion. MRI of the left ankle shows cystic changes within the talus and first cuneiform bones, as well as a lobulated abnormal soft tissue density with low…
SAN FRANCISCO—What factors help determine whether or not inflammation resolves, leading to healing, or becomes chronic, leading to disease and tissue destruction? A number of important cells, including toll-like receptors, mast cells, anti-citrullinated protein antibodies, complement and interferon, all play their own role in this process. By understanding how they act in innate and adaptive…
SAN FRANCISCO—To unravel how out-of-control inflammation begins in rheumatoid arthritis and other diseases, one target for immunologists is the macrophage. Researchers discussed macrophage activation and other key drivers of inflammation at the 2015 ACR/ARHP Annual Meeting on Nov. 7. How macrophages behave when recognizing damage-associated molecular pathways (DAMPs) tells us more about why some inflammation doesn’t…
I tell my patients there are three types of science: 1) investigative science, which sometimes gets it right; 2) science in the courtroom, which is junk science; and 3) science in Washington, D.C., which is political science. Our decisions are based on art and science; our patients’ medications are brought to market based on science….
As much as 80% of employee turnover can be attributed to bad hiring decisions, the Harvard Business Review reported.1 And turnover costs are high—one report estimated them to be 100–300% of the base salary of a replaced employee (with 150% commonly cited).2 Given this, the importance of hiring the right employees can’t be underestimated. So…
SAN FRANCISCO—Early in his career, Daniel Kastner, MD, PhD, scientific director at the National Human Genome Research Institute, saw a 24-year-old patient with a lifelong history of recurrent fever and severe episodes of arthritis. A colleague told him it was most likely familial Mediterranean fever (FMF). There was little then known about its mechanisms, and…