The new coronavirus outbreak, COVID-19, reminds us how we have struggled to keep ahead of mutating pathogens through the ages.
Enemy at the Gates: The Emerging Threat of COVID-19
On Dec. 30, 2019, an ophthalmologist named Li Wenliang notified his colleagues about an illness that was reminiscent of severe acute respiratory syndrome (SARS) in a city in the Hubei province of China called Wuhan. As an ophthalmologist, this was not directly relevant to his practice; he merely wanted to warn colleagues that they might…
Case Report: Ultrasound Reveals Cause of Post-Arthroplasty Knee Pain
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…
JIA & the Temporomandibular Joint: Diagnostic Challenges & Treatment Options
Juvenile idiopathic arthritis (JIA) can affect all joints, including the temporomandibular joints (TMJs). For a long time, the TMJ was a “forgotten” joint in pediatric rheumatology, although Sir Frederick Still did comment on a small mandible in his first case series on juvenile arthritis in 1897. In recent years, more attention has been given to…
Yes, the FDA Employs Rheumatologists. Here’s Their Role.
Ever wonder what role physician regulators—rheumatologists, in particular—perform at the U.S. Food & Drug Administration (FDA)? “I am not sure that many practicing rheumatologists know there are clinicians who work for the FDA,” says rheumatologist Nadia Habal, MD, a medical officer in the Division of Pulmonary, Allergy, and Rheumatology Products at the FDA. “It would…
Not All Rheumatoid Factor-Positive Tests Mean RA
Angioimmunoblastic T cell lymphoma (AITL) is an aggressive, peripheral T cell, non-Hodgkin’s lymphoma with an incidence of 0.05 cases per 100,000 person-years in the U.S., and it typically manifests in adults older than 60 years.1,2 AITL was previously known as angioimmunoblastic lymphadenopathy with dysproteinemia, immunoblastic lymphadenopathy or lymphogranulomatosis X, due to the hypothesis that the…
Case Report: A Patient’s Clubbing & Arthralgias Resist Diagnosis
A 59-year-old woman presented to our rheumatology clinic with a six-month history of a symmetric polyarthritis. She initially experienced pain in both knees. As time progressed, she began to notice pain in her ankles, hips, shoulders, hands and feet. She experienced joint stiffness lasting for more than 30 minutes every morning. She also described worsening…
New Study Sheds Light on Deficiency of Adenosine Deaminase 2 (DADA2)
Since it was first described, the spectrum of disease caused by deficiency of adenosine deaminase 2 (DADA2) has been broadening. Features described include systemic vascular and inflammatory features and recurrent stroke, which overlap with childhood-onset polyarteritis nodosa (PAN). Previous data show that DADA2 has extensive genotypic and phenotypic variation.1 Results from a recently published study…
New Study Identifies How Big a Role Diet Plays in Hyperuricemia
Living like a king has its price. And while kings and queens are primarily something of yesteryear, the vast majority of those living in reasonably wealthy nations can now live like kings. Now, back to that price. Gout, once known as the disease of kings, has been around at least since the time of the…
Do You Know Your Legal Obligations to Disabled Patients?
The Americans with Disabilities Act (ADA) was passed in 1990 to protect the civil rights of people with disabilities. This law, and amendments passed in 2008, resulted in rules and regulations opening access to private settings serving the public, including doctors’ offices and medical facilities. The ADA includes a three-pronged definition of disability. If any…
Experts Offer Tips for Saving Time on Electronic Medical Records
ATLANTA—“Bane of our existence” and “pajama time”—the dreaded time spent at night catching up on documentation—are a couple of phrases associated with the electronic medical record (EMR). To try to ease the frustration and limit the amount of time physicians have to spend using the systems, two experts reviewed tools and tricks for Epic and…
The Latest Advances in Sjögren’s, Scleroderma, RA, Gout & More
ATLANTA—At the ACR/ARP 2019 Annual Meeting, several widely renowned experts across an array of specialty subjects provided a comprehensive and compelling review of advances in the understanding, diagnosis and treatment of a number of rheumatologic conditions. Sjögren’s Syndrome Frederick Vivino, MD, FACR, chief of rheumatology at Penn Presbyterian Medical Center and professor of clinical medicine…
The Doctor Will See You Now: Legal & Regulatory Reforms Expand Telemedicine
In this time of COVID-19, you may be considering ways to deliver routine rheumatologic care via some form of telemedicine. Here are some of the legal considerations.
Patient Sexual Orientation & Gender Identity: Do You Need to Know?—Ethics Forum
A 17-year-old girl presents to the pediatric rheumatology clinic for follow-up of recently diagnosed systemic lupus erythematosus (SLE) characterized by class IV lupus nephritis, photosensitive rash and antiphospholid antibody positivity. She is currently being treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. She is accompanied by her mother, who has been very involved in the patient’s…
Risankizumab & Apremilast Come to Market in Canada
In Canada, five provinces will now reimburse patients with plaque psoriasis who use risankizumab. Also, Canada Health has approved apremilast for treating adults with plaque psoriasis and psoriatic arthritis…
Phase 3 Results for Olokizumab in RA Patients
In a recent study, olokizumab proved safe and effective for treating the signs and symptoms of RA and improving patients’ physical function…
CSE Award Provides Financial Support & Creates Practice Community for Recipients
Investing in rheumatology training is essential to building a strong and capable workforce. Clinician educators are responsible for developing educational programs, instructing rheumatologists to meet accreditation standards and promoting an atmosphere of quality care for patients. Although clinician educators play a critical role in attracting the next generation of rheumatology professionals, faculty pursuing careers as…
ACR Expands Access to Education through Education Partner Program & New Spotlight Slide Decks
In conjunction with the 2019 ACR/ARP Annual Meeting, the ACR piloted two new programs to provide learners with deeper, more diverse educational experiences outside of attending medical conferences. Education Partners The ACR Education Partner Program allows rheumatology professionals to consume research from the 2019 ACR/ARP Annual Meeting via multimedia video and audio platforms. A call…
Analysis of National & Local Coverage Determinations
The Medicare statute states that items and services provided to beneficiaries must be “reasonable and necessary” to qualify for reimbursement. Although the Medicare program determines in specific cases whether an item or service is reasonable and necessary, it also issues policies, called coverage determinations, to instruct Medicare Administrative Contractors (MACs) what to reimburse providers for….
Coding Corner Questions: An Office Personnel Quiz
A 65-year-old male patient diagnosed with rheumatoid arthritis at multiple sites without rheumatoid factor has been ordered to have infliximab infusions. What should support staff do to ensure this procedure can be given to the patient? Make sure there is a signed order from the provider Make sure a prior authorization is obtained Make sure…
Coding Corner Answers: An Office Personnel Quiz
Take the challenge. D. When an infusion is ordered by the provider, there should be a signed order from the provider. If a prior authorization is needed, it should be obtained, with the number of infusions, along with the start and end dates of the authorization. Also, a prior authorization does not guarantee reimbursement; an…