First Appearances I watched the old man, his back painfully bent, shuffle toward the scale. A blocky rigidity draped over him. His feet seemed stuck to the floor. His head hung heavily over his chest. Observing him from the end of the hallway, instead of a face, I saw only a mound of shaggy, matted…
Your home & your health: Does geography impact medicine? Does it matter whether a region is surrounded by large bodies of water, encircled by towering mountain peaks or that its residents share a common ancestry? Consider Switzerland, a nation with a highly developed economy replete with advanced technological and medical infrastructure. Despite these advantages, less…
Rheumatology is at a critical juncture in our history. To advance into the future, the ACR must thoroughly prepare for changing political landscapes, emerging technologies and workforce challenges. On May 12, the ACR Board of Directors met in Washington, D.C., to approve our ambitious new Strategic Plan for 2017–2022. This plan encompasses five strategic themes…
I was driving to work one morning when I stopped behind a truck at a red light. The driver had placed several flashy stickers on the bumper and back doors. But what I was drawn to was a more commonplace sign: “How’s my driving? Call this number to give feedback.” It’s routine to find a…
Management of rheumatoid arthritis (RA) is complex. The ever-expanding availability of new drugs requires that rheumatologists and patients constantly consider treatment strategies and targets aimed at both disease control and symptom relief while remaining cognizant of the increasing high cost of emerging medications. Given such complexity, guidelines to inform rheumatologists about the most recent developments…
“I was hoping for good news, but now I am worried,” was the response of a 29-year-old patient when I suggested an oncology referral. He was four months into treatment of dermatomyositis and had experienced significant improvement of his muscle strength, CPK levels and interstitial pneumonitis, but a follow-up CT scan showed that his spleen…
This year the ARHP Clinical Focus Course brings together experts in the field to provide an interprofessional approach to the management of systematic lupus erythematosus (SLE) to improve patient outcomes. The daylong course, titled Systemic Lupus Erythematosus: Taming the Wolf—Salient Lessons from Practice and Research, which is offered on Nov. 4, will provide a case-based…
Questions that come to mind when you are specialized within a subspecialty: How can I build a network of peers? Where can I find resources and tools that apply to me? Do organizations exist that can provide me with opportunities for growth and leadership? As a pediatric nurse practitioner in rheumatology at Nationwide Children’s Hospital…
CHICAGO—Caryn A. Libbey, MD, clinical associate professor of medicine at Boston University School of Medicine, described the evolving in our understanding of amyloid at the ACR’s State-of-the-Art Clinical Symposium in April. Amyloidosis is a rare disease that is often underdiagnosed and undertreated. “Even though this disease has been around for 150 years, I still consider it…
CHICAGO—Doruk Erkan, MD, MPH, a rheumatologist at the Hospital for Special Surgery and Weill Cornell Medicine in New York City, described recent developments in the field of antiphospholipid syndrome (APS) to the rheumatologists gathered for the ACR’s State-of-the-Art Clinical Symposium in April. He introduced APS as a “field with limited data and lots of controversies,” although,…
CHICAGO—Sherine E. Gabriel, MD, MSc, professor of medicine at Rutgers Medical School in Newark, N.J., and a past president of the ACR, presented an overview of cardiovascular disease and rheumatology on a Saturday morning to a room overflowing with rheumatologists attending the ACR’s State-of-the-Art Clinical Symposium in April. She noted that physicians have known for a…
CHICAGO—Warren Piette, MD, professor of dermatology at Rush University Medical Center, Chicago, updated rheumatologists on the topic of cutaneous vasculitis at the ACR’s State-of-the-Art Clinical Symposium in April. He began by explaining that the current vasculitis criteria developed by the ACR in 1990 and the Chapel Hill Consensus Conference (CHCC) in 1994 are inadequate to incorporate…
CHICAGO—On a Saturday morning in Chicago, Chester V. Oddis, MD, director of the Myositis Center at the University of Pittsburgh, explained to a crowded room of about 500 rheumatologists attending the ACR’s State-of-the-Art Clinical Symposium in April how best to use myositis autoantibodies in clinical care. He began with an overview of the different types of…
CHICAGO—A clustering of cases in Lyme, Conn., in 1975 led to the discovery of Lyme disease. Allen C. Steere, MD, professor of medicine at Harvard Medical School in Boston, investigated that outbreak, and he shared his knowledge of Lyme disease with rheumatologists gathered at the ACR’s State-of-the-Art Clinical Symposium in April. He explained that Lyme arthritis…
CHICAGO—Leonard H. Calabrese, DO, professor of medicine at Cleveland Clinic in Ohio, presented on emerging concepts of viral infections and rheumatic disease at the ACR’s State-of-the-Art Clinical Symposium in April. “We are at a pivotal point in rheumatology in understanding the relationship between viruses and rheumatic disease,” began Dr. Calabrese. “It’s a very exciting time.” Dr. Calabrese…
CHICAGO—Delia Chiaramonte, MD, associate director of education at the Center for Integrative Medicine at the University of Maryland School of Medicine in Baltimore, presented the newest thinking on pain to a gathering of rheumatologists at the ACR’s State-of-the-Art Clinical Symposium in April. She began by explaining that pain is more than nociception. Nociception stimulates nerves to…
Social media has revolutionized my practice. I stay current with Twitter content from other rheumatologists, patient organizations and medical journals. I am also an active member of the international Twitter-based rheumatology journal club, #RheumJC. Still, I was recently surprised when my patient’s name appeared in a friend request. This same patient was following me on…
Romosozumab’s Future Is Uncertain Romosozumab, which has the possible U.S. brand name Evenity, is awaiting approval from the FDA.1 The treatment is an investigational, injectable biologic for treating osteoporosis. It increases bone formation and bone density, reducing a patient’s risk of fractures. The manufacturer no longer expects the FDA to approve the drug this year…
On July 3, the Rheumatology Research Foundation announced the names of 63 rheumatology trainees, educators, clinicians, investigators and health professionals who will receive Foundation-funded awards. In support of the Foundation’s mission to improve the health of people with rheumatic diseases, the awards help recruit and train the next generation of rheumatology professionals and advance research…
Awareness can be an ambiguous term, but it makes all the difference in rheumatology. The first weeks and months following the onset of rheumatic disease symptoms are known as the window of opportunity. Prompt treatment can prevent damage to joints and other organs, improve long-term function and increase the likelihood of achieving disease remission. But…
The U.S. Congress refers to the bicameral legislature, consisting of the 435 voting and six non-voting members of the House of Representatives and the 100 members of the Senate. When we visit D.C. or express our policy positions to Congress, our message would ideally reach every member. The ultimate goal is to reach all 535…
The levels of service within an evaluation and management (E/M) visit are based on the documentation of key components, which include history, physical examination and medical decision making. The history component is comparable to telling a story and should include a beginning and some form of development to adequately describe the patient’s presenting problem. To…
A 66-year-old female patient returns to the office complaining of swelling and a burning pain in her right first toe. She rates the pain level at a 9 out of 10. She currently takes an over-the-counter non-steroidal anti-inflammatory drug (NSAID), but it has done little to alleviate the pain. This is her second episode this…
Take the challenge. CPT: 99214-25, 89060, 20600-RT ICD-10: M10.271, T50.2X5A, I10 This is an established outpatient visit. This encounter is coded as 99213, because it included: History—Detailed: The history of present illness is extended, the review of systems is extended, and the past medical and social histories are documented. Examination—Detailed: Seven organ systems are examined….