“RISE is a tool designed by rheumatologists, for rheumatologists. I would encourage everyone to give it a try, watch our demo and learn about our results. We now have over 900,000 patient encounters, and the growth of the registry has been amazing. With your participation, it will develop into a powerhouse of knowledge. It’s so…
It has been nearly 35 years since the original descriptions of what now is recognized as AIDS (the acquired immune deficiency syndrome), an advanced form of infection secondary to the human immunodeficiency virus (HIV). The epidemic of HIV infection remains the singular most dramatic epidemic of our generation and will likely remain with us for…
Clinical Vignette A 45-year-old woman with long-standing asthma and chronic sinusitis has new-onset peripheral neuropathy, arthralgias, fatigue, progressive dyspnea and a nonproductive cough. She has never smoked and has no environmental exposures. Her medications include an albuterol metered-dose inhaler (which she uses daily); an inhaled corticosteroid, montelukast; and ibuprofen (which she takes occasionally). She is…
A single injection daily of zoledronic acid may improve bone mineral density (BMD) in frail elderly women in long-term care facilities, a new randomized controlled trial shows. However, the clinical importance of the improvement, observed over a two-year period, remains unclear, Dr. Neil M. Resnick, of the University of Pittsburgh, told Reuters Health in a…
Patients with systemic lupus erythematosus (SLE) are characterized by high-titer, highly specific, isotype-switched antibodies against DNA and RNA. Patients have both CD4+ T helper (Th) cell- dependent as well as Th cell-independent autoantibody production. Two mouse models of lupus demonstrate T-cell–independent autoantibody production: the pristane model of lupus, as well as in the MRL/lpr mouse…
It seems to have begun in Norway, the international pressure to switch patients from well-known brand biologic agents, such as Remicade (infliximab), to biosimilar agents, due to a significant cost advantage.1 This biosimilar came with a 39% price markdown last year compared with the brand, and when Norway called for bids, the discount went to…
Although compelling data exist to support a link between periodontal disease (PD) and the development of rheumatoid arthritis (RA), cementing the association will require extensive investigative work.1 However, in reviewing the literature of the past 10 years, Elliot D. Rosenstein, MD, director, Institute for Rheumatic and Autoimmune Diseases at Overlook Medical Center, Summit, N.J., and…
Rheumatologists have growing concerns about how we manage rheumatoid arthritis (RA) and the disease outcomes we are achieving.1 Over the past two years, clinician rheumatologists have begun working together to address these problems through the Rheumatoid Arthritis Practice Performance (RAPP) Project, a nationwide clinical quality-improvement initiative. The RAPP Project has now grown to 168 participants…
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…
It’s disheartening to stand by and watch helplessly as your patient dies a slow, painful death. In spring 1990, I had the misfortune of living through such a distressing experience. Strange happenings in New Mexico & Japan Ellen was a bookkeeper in her late 40s, living quietly in suburban Boston. For years, she hid a…
The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) invite you to submit an abstract and take advantage of the opportunity to have your work peer reviewed by experts in rheumatology. Reasons to Submit Opportunity for Publication—The Annual Meeting draws thousands of abstracts submitted by rheumatology professionals from around the…
For 30 years, the Rheumatology Research Foundation has been funding research and advancing treatments. During that time, Leonard L. Dragone, MD, PhD, received a Foundation award to help look for new strategies to treat autoimmune and inflammatory diseases in mouse models. Then, he was working as an assistant professor of pediatrics and immunology at the…
Can merely crossing your fingers change the way your brain perceives pain when you touch different stimuli with three fingers? Perhaps so, according to a new study by UK-based researchers, when taken into context with the immediate environment. Changes in posture could potentially provide a way to influence chronic pain if basic science results lead…
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…
At this year’s ACR/ARHP Annual Meeting in San Francisco, you can take advantage of a variety of sessions designed to address pressing concerns in practice management today. Practice managers, clinicians, office staff and others will enjoy and benefit from hands-on practical sessions and informative panel discussions by top content experts in the field. Here are…
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…
Dear ACR and ARHP Colleagues, In 2007, the ACR created RheumPAC as the need for strong advocacy for rheumatologists and their patients and rheumatology training and research became compelling. The Government Affairs Committee was adept at developing novel ideas and strong policies, but there was a notable gap between policy and politics. RheumPAC was started…
Although close collaboration with a variety of specialists outside of rheumatology is important, you could make the case for rheumatologists and pulmonologists having to work together even more closely. If lung symptoms are severe and not under control, the results could be fatal. However, the question sometimes is when to refer—even when there are not…
Editor’s note: This is the first installment of a two-part series showing how a busy office-based practice can incorporate patient advocacy into its standard workflow. Part 1 outlines the reasons for advocacy and the benefits to both patients and doctors, then gives a quick-start outline to get you started. Part 2 will amplify the concepts…
Questions, concerns and spirited debate have surrounded the Graduate Medical Education (GME) system for decades. The program that trains nearly 120,000 physicians per year is under constant scrutiny.1 Changes to the political landscape, combined with ongoing efforts by health industry payers and regulators to squeeze inefficiency out of the system, have kept the GME in…
Studies suggest that physicians rate between 10 and 15% of patient visits “difficult.”1 This is important for a variety of reasons: Patient satisfaction is a frequently measured parameter, and poor interactions may lead to bad ratings. Personal satisfaction on the part of the provider is also an issue, and frustrating interviews can leave the physician…
The beep of the cellphone text got me off the armchair. I had been feeling cozy and comfortable. Outside the window, it was a blissful winter wonderland—the one, I believe, Nat King Cole intended when recording “The Christmas Song.” But at the same time, I was anxious to hear whether my clinic would be canceled…
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…
Rheumatologists worried about the future of their private practices might want to consider jumping onto the super group trend that allows physicians and other providers with similar services to team up to share opportunities and minimize financial burdens. The biggest concern for private practice physicians watching the trend but not yet embracing it is fear…
Case You’ve been asked to see an inpatient for a rheumatologic consultation. After seeing the patient, you enter an initial consult note in the electronic medical record (EMR). The next day, when you write a follow-up note for this patient, you copy part of your assessment and plan from your prior note. Soon after you…
Whether you’re considering selling your practice, growing your practice or maintaining the status quo, it’s important to periodically do a checkup on your internal operations and compliance with the law. It’s always preferable to discover problems within your practice and correct them (if possible) before those issues are discovered by third parties, such as the…
Jonathan Hausmann, MD, a pediatric and adult rheumatology fellow at Beth Israel Deaconess Medical Center and Boston Children’s Hospital, remembers seeing a patient with a red, swollen and tender big toe early in his fellowship and diagnosing his patient with gout. He was happy to be able to help the patient, and he called in…
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…
Bonus: Listen to excerpts from our conversation with Dr. Weinblatt. Michael Weinblatt, MD, is the co-director of clinical rheumatology at Brigham and Women’s Hospital in Boston, a professor of medicine at Harvard Medical School, past president of the American College of Rheumatology, and co-director of the ACR Winter Rheumatology Symposium at Snowmass, Colo. Those are…
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…
Ankylosing spondylitis primarily affects the joints and ligaments of the spine, but may also have an impact on other joints. Patients experience pain and stiffness that limit mobility in the back and other affected joints. Symptoms can come and go, last for long periods of time and be severe. Anti-tumor necrosis factor (anti-TNF) drugs are…
Study proposes increased active C5a recruits neutrophils to arthritic joints to maintain inflammation
Rheumatologist denounces common practice as a time-draining impediment to patient care