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The Rheumatologist: April 2021

The ACR Addresses Vaccine Challenges

David R. Karp, MD, PhD  |  February 18, 2021

An ACR COVID-19 Vaccine task force examined vaccine data and literature to evaluate COVID-19 vaccine safety, efficacy and interaction with medications for patients with rheumatic and musculoskeletal diseases, and to craft a living guidance document for members.

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ACR, Ophthalmologists & Dermatologists Issue Joint Hydroxychloroquine Statement

Ruth Jessen Hickman, MD  |  April 17, 2021

Since 1991, hydroxychloroquine (HCQ) has been a staple for the treatment of patients with systemic lupus erythematosus; it has been shown to improve survival, reduce cardiovascular risk, thrombosis and renal damage, delay or prevent lupus cerebritis and more. However, HCQ can potentially bind in the retinal pigment epithelium and cause degeneration of photoreceptors, leading to…

Adventures in Vaccinating

Philip Seo, MD, MHS  |  April 17, 2021

I’m a believer in blue light. I’ve spent years lecturing my insomniac patients, buzzed on prednisone, on the importance of good sleep hygiene. In my own home, I try to practice what I preach. When I’m ready for bed, I leave my laptop and phone on my nightstand, and concentrate on relaxing. If I can’t…

Wisconsin Rheumatology Association Targets Rural Workforce Shortages, Advocacy Needs

Linda Childers  |  February 26, 2021

Now in its 16th year, the Wisconsin Rheumatology Association engages and supports rheumatology professionals through advocacy sessions, annual meetings and continuing medical education-accredited events.

Clockwise from top: Image A shows the periungual ulceration (arrow) of the fifth digit, as well as the prior amputation of the second digit. Image B shows a longitudinal ultrasound of the palmar aspect of the ulnar right wrist. In the center of the image, the ulnar artery is in view and color Doppler flow is visualized within the vessel until there is a reversal of flow demonstrated by color change, followed by severe attenuation of flow distally. Distal to the cessation of flow, the vessel appears hypoechoic due to proliferation of the intima to the point of occluding the lumen. Image C shows a transverse view at the level of white line in Image B, with endothelial proliferation seen around a central lumen of the artery (a), next to the vein (v) and ulnar nerve (n). Image D, shows a transverse view at the level of the black line in Image B, where the arterial lumen (a) is occluded.

Insights Into Ulnar Artery Occlusion in Systemic Sclerosis

Devin M. Driscoll, MD, Andreea M. Bujor, MD, PhD, & Eugene Y. Kissin, MD, Rhmsus  |  April 17, 2021

A 51-year-old man with a history of limited systemic sclerosis with Raynaud’s phenomenon and pulmonary hypertension being treated with tadalafil and macitentan presented to a clinic with ulceration of his right pinkie. The patient had injured the finger two months earlier. He reported poor healing and the presence of a persistent ulcer since the injury….

What the ARP & the College Are Doing For You

Christine Stamatos, DNP, ANP-C  |  April 17, 2021

As we emerge from the grips of a global pandemic, we are taking this opportunity to pause and reflect on the ARP and what our division brings to the care of our patients. I found the words of Amanda Gordon’s inaugural reading of her poem, “The Hill We Climb,” inspirational and instructive for our past,…

Marc R. Chevrier, MD, PhD, FACR, Lupus Research Memorial Fund Established

From the College  |  April 17, 2021

The Lupus and Allied Diseases Association Inc. established the Marc R. Chevrier, MD, PhD, FACR, Lupus Research Memorial Fund at the Rheumatology Research Foundation, effective March 1. This fund was established to honor the life and legacy of Marc Chevrier, MD, PhD, FACR, a pioneer and patient advocate in the field of lupus. About Dr….

A Lack of Pediatric Providers Can Have Long-Term Consequences

Kimberly Retzlaff  |  April 17, 2021

As with rheumatology care in general, the current demand for pediatric rheumatologists is greater than the supply of providers available. That imbalance is expected to increase significantly by 2030 unless action is taken, according to a new workforce study published in Arthritis Care & Research.1 The lack of pediatric providers is a serious problem that…

A Team Approach Improves the Transition from Pediatric to Adult Care

Rosemary Peterson, MD, MSCE, & Joyce Chang, MD, MSCE  |  April 17, 2021

Nearly all adolescents and young adults (AYAs) with chronic pediatric rheumatic disease require transfer of care to an adult rheumatologist, yet almost half are lost from care at the time of transfer.1-3 Although sometimes framed as a discrete event, transition refers to the longitudinal process, often spanning several years, in which AYAs and their families…

Case Report: Rapidly Progressive Interstitial Lung Disease in a 6-Year-Old

Anusha Vuppala, MD, & Sarwat Umer, MD  |  April 17, 2021

Clinically amyopathic dermatomyositis (CADM), a rare subset of dermatomyositis (DM), is an autoimmune disease characterized by cutaneous findings of typical DM without evidence of myositis. Childhood presentation of CADM is rare, and not many studies describe the epidemiology of juvenile CADM.1,2 Although lung disease is rare among patients with juvenile DM, a few reports have…

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Months After COVID-19 Infection, Rheumatic-Like Symptoms Persist

Mary Beth Nierengarten  |  April 16, 2021

As more people get vaccinated for COVID-19, there’s hope that the long days of a pandemic, which has claimed more than 2.5 million lives globally and 500,000 in the U.S., will soon draw to a close and allow daily life to return to normal. However, for some people, this recovery may take longer, because the…

Food, Diet, Nutrition & Rheumatic Diseases—Are They Really Related?

Brendan Cerk, MD, & Richard S. Panush, MD  |  April 17, 2021

“‘I didn’t say there was nothing better,’ the King replied. ‘I said there was nothing like it.’” —Lewis Carroll, Through the Looking Glass “Why did I get this? Was it because of my diet? What should I eat now? What diet should I follow? Are there any natural treatments I can take instead of medications?”…

COPA Syndrome: What Do We Know About This Rare Disease?

Lara C. Pullen, PhD  |  April 17, 2021

ACR CONVERGENCE 2020—Tiphanie Phillips Vogel, MD, PhD, assistant professor of pediatrics and internal medicine at Baylor College of Medicine, Houston, moderated the session on COPA syndrome, which drew 324 attendees on a Sunday morning. This rare genetic cause of immune dysregulation can present like anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis, lupus, lupus nephritis or rheumatoid…

Grit, Gratitude & Grace: Resilience Despite the Pain

Mary Beth Nierengarten  |  March 24, 2021

Clinicians can help their patients tap into personal resilience, and such characteristics as grit, gratitude and grace, to manage their chronic pain, says Afton L. Hassett, PsyD.

RheumPAC: A Wise Investment to Let Your Voice Be Heard in Washington, D.C.

From the College  |  April 5, 2021

ACR/ARP members share why they support the ACR’s nonpartisan political action committee and see it as an investment in the future of rheumatology.

Late Spring 2021’s Awards, Appointments & Announcements in Rheumatology

Gretchen Henkel  |  April 17, 2021

AMA Honors Mark Andrejeski with Lifetime Achievement Award In November 2020, the American Medical Association (AMA) presented Mark Andrejeski, the recently retired executive vice president of the ACR, with its Medical Executive Lifetime Achievement Award. The award honors a medical association executive who has contributed substantially to the goals and ideals of the medical profession….

The 21st Century Cures Act Information-Blocking Rule

Steven M. Harris, Esq.  |  April 17, 2021

The 21st Century Cures Act (Cures Act) became law on Dec. 13, 2016, and emphasized interoperability in the exchange of healthcare information between healthcare providers, health information entities and patients. The Cures Act underscored unimpeded access to patient electronic health information (EHI) upon request, in a manner that is secure and updated automatically, and prohibits…

Rheum After 5: Dr. Stuart Kassan, Golf Enthusiast

Carol Patton  |  April 17, 2021

About 10 years ago, Stuart S. Kassan, MD, FACP, MACR, was playing in a local golf tournament at the Denver Country Club. Each player had to tee off over a water hole in front of roughly 100 club members. His ball was the only one that landed in the water—twice. He was introduced to golf…

FDA Approves Belimumab & Voclosporin for Lupus Nephritis

Michele B. Kaufman, PharmD, BCGP  |  March 24, 2021

In December, the FDA approved belimumab, the first drug approved to treat lupus nephritis, an historic action that was rapidly followed in January by the approval of a second treatment for lupus nephritis, voclosporin.

Letter: Lupus Enteritis

Graciela S. Alarcón, MD, MPH, MACR  |  March 15, 2021

I read with interest the case report of a patient with lupus enteritis in the February 2021 issue of The Rheumatologist, and I thought the diagnostic approach and final diagnosis were very well presented; however, I noticed an omission which in my view is quite relevant to this patient’s overall management and to so many…

Letter: Empathy in Medicine

Raheem Nazeer, MD, FACR  |  April 17, 2021

For years now, I have read The Rheumatologist cover to cover (but only glance at the ads, but don’t tell the advertisers that). Len Calabrese’s piece, “The Science of Empathy in Rheumatology” in the January 2021 issue, hits the central point in medical care. I would like to believe that it has been empathy that…

Safe Step Act of 2021 Aims to Put Patients First

From the College  |  March 5, 2021

Introduced in the Senate on Feb. 25, the bill would amend the Employee Retirement Income Security Act to provide a clear process and circumstances for requesting medical exceptions to step therapy protocols.

Denosumab Has Edge on Alendronate for Steroid-Induced Bone Loss

Matthew Phelan  |  March 10, 2021

NEW YORK (Reuters Health)—Long-term glucocorticoid users see greater gains in spine bone-mineral density when treated with the monoclonal antibody denosumab vs. oral alendronate, a small clinical trial shows. The drug also proved superior at lowering bone-turnover markers at 12 months, researchers in Hong Kong report in Bone.1 “Denosumab may be considered as an alternative first-line…

Micromotors Promising for Rheumatoid Arthritis Therapy

Marilynn Larkin  |  March 10, 2021

NEW YORK (Reuters Health)—Magnesium-based micromotors showed promise as a delivery system for hydrogen therapy to inflamed joints in an experimental model of rheumatoid arthritis, researchers say. Hydrogen gas has been shown to neutralize overproduction of reactive oxygen species (ROS), which can degrade cartilage and bone and activate inflammatory cytokines, according to Dr. Yingfeng Tu of…

A New Era of Coding Evaluation & Management Services

ACR Practice Management Staff  |  January 25, 2021

After 25 years, the American Medical Association (AMA) Current Procedural Terminology (CPT) office and outpatient evaluation and management (E/M) codes received a major overhaul. These changes, which went into effect Jan. 1, will help reduce administrative burden on providers and roll back some of the rigid requirements for E/M coding by simplifying the code selection…

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