The ACR is searching for practicing physicians interested in coding and reimbursement issues to represent the ACR on the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) Committee. The RUC and CPT Committee comprise physicians representing the national medical specialty societies who advise the CPT Editorial Panel on matters concerning…
The ACR’s Advocates for Arthritis 2016 Legislative Fly-In Heads to Capitol Hill
On Sept. 12–13, ACR advocates will be back on Capitol Hill as part of the Advocates for Arthritis legislative fly-in. This annual event brings together rheumatology professionals and patients to advocate on behalf of the rheumatology community. The core issues on which the advocates will focus this year include advocating for dramatic changes to the…
Transition to ICD-10 Diagnostic Code Set Successful for Most Rheumatology Practices
It has been 11 months since the implementation of the ICD-10 diagnostic code set on Oct. 1, 2015, a change from the previous ICD-9. Most practices can probably attest that the transition came and went without the predicted doomsday outcome: Claims were still processed, the confused alphanumeric coding was applied, and patients were not deprived…
When Rheumatologists Are a Patient’s Second or Third Choice for Medical Opinion
Outside Exam Room No. 5, the chart rack was empty, so I assumed my new consult was late. Just in case, I looked back over my shoulder as I passed by the partially open door and glimpsed the lower half of a woman holding a three-ringed binder on her lap. I squinted and took a…
When Medical Workforce Grievances Lead to Strikes
Picket Lines: June 27 was marked on my calendar as the day to watch. No doubt the union organizers shrewdly selected it to be their strike day because of its proximity to July 1, an auspicious date for teaching hospitals, when rookie interns and residents anxiously assume their heightened roles of responsibility within the medical…
The ACR’s Workforce Study Group to Release 2015 Survey Results
The ACR and its Rheumatology Research Foundation continue to work together to provide support for the rheumatology and patient communities. Both organizations are committed to advancing the field of rheumatology with a dedication to expanding the workforce. With a growing number of patients being diagnosed with a rheumatic disease and living longer with the disease,…
Long-Term Antibiotic Treatment for Lyme Disease Shows No Benefits
For people in whom symptoms of Lyme disease persist beyond the standard course of two to four weeks of antibiotic therapy, longer term antibiotic treatment provides no additional benefits beyond the shorter term course. This is the conclusion of a recent study published in the New England Journal of Medicine that builds on a number…
Pain Linked to Inflammatory Lesions in Knee Osteoarthritis
Inflammation in the knee was found to be associated with development of pain sensitization in recent research with a cohort from the Multicenter Osteoarthritis Study (MOST). This research finding may indicate that targeting of inflammation could help reduce pain severity in knee osteoarthritis (OA). Tuhina Neogi, MD, PhD, says that her and her colleagues’ research,…
Rheumatoid Arthritis Patient Shares Lessons Learned from Breaking Leg in a Fall
Humpty Dumpty sat on a wall Humpty Dumpty had a great fall All the king’s horses and all the king’s men Couldn’t put Humpty together again. —Mother Goose I feel like a female Humpty Dumpty. Recently I took a great fall, and now I am in the process of being put together again. I was…
Chronic Reactive Arthritis Secondary to Intravesical Bacillus Calmette–Guerin in Bladder Carcinoma
A 50-year-old man with history of superficial bladder carcinoma presented to our rheumatology clinic for a three-year history of symmetric polyarthralgias. He had undergone multiple transurethral resection of bladder tumor procedures and bacillus Calmette–Guerin (BCG) treatments. Prior to receiving BCG, he was fully functional and employed. Days after receiving his second BCG treatment, he developed…
Total Joint Arthroplasty Outcome Measures Toolkit Helps Rheumatologists’ Post-Surgical Assessments
Amir Atwal* is a 76-year-old man who had a knee arthroplasty six weeks ago: He wonders how he is doing in comparison to other individuals of his age at the same stage of recovery. Will you be able to provide him with an answer? If you are looking for a one-stop shop to help you…
Blacks, Asians at Higher Risk for Allopurinol-Related Skin Reactions
Be careful when prescribing allopurinol to black and Asian gout patients, a study newly advises. Black and Asian patients who take this ubiquitous, more-than-40-year-old medication are at much higher risk of certain serious skin reactions than are Caucasians or Hispanics. Compared with Caucasians, blacks who take allopurinol to lower blood urate levels have an increased…
Understanding Prescription Pathways for Biologic Medication Therapy
Executing evidence-based medicine in the U.S. is challenging, especially utilizing high-cost medications in rheumatologic care. As patients trust their clinicians to be their medical experts, clinicians must trust their care team members to be experts at implementing the care plan. A clinician’s knowledge of human anatomy and physiology is the foundation to understanding pathophysiology. From…
Possible Impact of Biosimilar Infliximab on U.S. Market in Prescriptions, Pricing
The use of biosimilars for rheumatology in the U.S. became a reality when the U.S. Food and Drug Administration (FDA) approved Inflectra (infliximab-dyyb), a biosimilar to Remicade (infliximab), in April. What this may mean is increased competition among drug companies with regard to pricing and, therefore, potentially lower costs for U.S. patients, according to Seoyoung…
Sexual Dimorphism Found in Immunologic Profiles of Patients with Ankylosing Spondylosis
A study that found distinct sexual dimorphism in the immunologic profiles of patients with ankylosing spondylosis (AS) suggests that sex is an important variable to address in future research and may eventually lead to more effective sex-specific therapy for patients with the disease. The research, published in the March 2016 issue of Arthritis & Rheumatology,…
Lung Complications Closely Entwined with Rheumatologic Diseases
SAN FRANCISCO—Lung involvement is a frequent and often life-threatening manifestation of the connective tissue diseases (CTDs) that are commonly encountered by rheumatologists. A variety of rheumatic diseases can affect the lungs, including systemic sclerosis, rheumatoid arthritis, vasculitis, lupus, polymyositis/dermatomyositis (PM/DM) and Sjögren’s syndrome. A panel presentation on lung disease associated with rheumatic diseases at the…
Why Rheumatologists Should Ask Patients About Drug Use
SAN FRANCISCO—“We’ve known for a long time that prescription medications and illicit drugs can both mimic and actually induce the autoimmune syndromes treated by rheumatologists,” Jonathan Graf, MD, professor of medicine at the University of California–San Francisco in the Division of Rheumatology at Zuckerberg San Francisco General Hospital (SFGH), said at the California Rheumatology Alliance…
Research on Ixekizumab in Psoriatic Arthritis and More Presented at EULAR 2016
LONDON—Results from the extension phase of a Phase 3 trial for the IL-17A inhibitor ixekizumab in psoriatic arthritis (PsA) show that patients started on placebo, adalimumab and ixekizumab continued to show improvements in arthritis, dactylitis and ethesitis, said Philip Mease, MD, a rheumatologist at Swedish Medical Center University of Washington in Seattle.1 Dr. Mease presented the…
Potential Benefits, Pitfalls of Biosimilars Reviewed at EULAR 2016
LONDON—The availability of a biosimilar form of infliximab has dramatically increased the number of Norwegians taking one form or another of the drug, an expert on biosimilars said in a debate-style session at the Annual Congress of the European League Against Rheumatism (EULAR 2016). The expanded uptake of Remicade (infliximab) and its biosimilar, Remsima (international…
Diagnostic Criteria, Classification Lacking for Vasculitis; New Research in Treatment for Systemic Sclerosis
LONDON—Despite the detailed terminology for describing vasculitis established by the Chapel Hill Consensus (CHC) in 2012, the field badly needs better classification and diagnostic criteria for the group of diseases, an expert said in a presentation at the Annual Congress of the European League Against Rheumatism (EULAR 2016). It’s a topic that is now being…
New Research into Rheumatoid Arthritis, Gout Includes Updates on Methotrexate, Biologics, Ultrasound
LONDON—From optimizing responses to methotrexate, to the efficacy of biologics, to the need for imaging in assessing remission, the literature, as ever, has been lively with explorations of pressing topics in the treatment and management of rheumatoid arthritis. Josef Smolen, MD, chair of rheumatology at the Medical University of Vienna, reviewed many of the highlights…
Progress Slow in Development of Useful Biomarkers for Rheumatoid Arthritis Treatment
LONDON—Josef Smolen, MD, chair of rheumatology at the University of Vienna and former president of the European League Against Rheumatism (EULAR), expressed a “personal disappointment” in the development of useful biomarkers in the treatment of rheumatoid arthritis (RA). Even though a good portion of his life’s work has been researching biomarkers to help with targeting…
Rheumatology Research Foundation Investigators’ Meeting Shares Advancements Toward a Cure
The Rheumatology Research Foundation hosted the 9th annual Investigators’ Meeting in Atlanta on June 24–25. As a requirement for Foundation innovative research and pilot grant recipients, Foundation-funded investigators meet annually to provide updates and status reports on the work they are doing to advance treatments and cures for rheumatic diseases. More than 50 attendees enjoyed…
Rheumatology Coding Corner Question: Level 4 New Patient Visit
A 32-year-old female patient comes in for an initial visit. She is self-referred and complains of pain, numbness and color changes in her fingers when exposed to cold. The patient reports that her right distal index finger, left distal index finger and fourth right finger turn white and blue with pain and numbness when exposed…
Rheumatology Coding Corner Answer: Level 4 New Patient Visit
Take the challenge. Correct Answer: CPT: 99204 ICD-10: I73.00 Coding Rationale This is a new patient, outpatient visit for a self-referred patient. There is no formal consultation request from another physician; therefore, the encounter does not meet criteria for a consultation. This encounter is coded as 99204 because it included: Comprehensive history—Extended history of the…
Rheumatologist, Sci Fi Fan Dr. Ernie Katler Showcases Star Wars Treasures in Office
When patients enter the rheumatology office of Ernie Katler, MD, FACP, FACR, in San Pablo, Calif., they’re transported to a galaxy far, far away. Hundreds of toys, props and figurines of Yoda, Darth Vader, Jabba the Hutt and other characters, as well as three original Star Wars movie posters, greet patients. If they’re lucky, patients…
Corticosteroid Use in Acute Polymyalgia Rheumatica Should be Reassessed
When I started my rheumatology practice 40 years ago, it quickly became apparent that many referrals of presumed polymyalgia rheumatica (PMR) patients and presumed giant cell arteritis (GCA) patients were the recipients of devastating side effects from long-term corticosteroid (CS) use that could not be discontinued due to prompt recurrence of inflammatory phenomena. It was…
What Rheumatologists Should Know about Purchasing a Healthcare Practice
After extensive research and careful deliberation, you have finally made the exciting but daunting decision to purchase a healthcare practice. You know that in the next couple of months you are going to need to examine the practice from a different perspective—one of a future owner. You also recognize that in order to facilitate the…
Ethics Forum: Prescribing Teratogenic Medications to Adolescents Can Raise Confidentiality, Ethical Concerns
Case A 17-year-old girl returns to the rheumatology clinic for scheduled follow-up for systemic lupus erythematosus (SLE). She is accompanied by her mother and father. She has a history of autoimmune cytopenias and Class III lupus nephritis. She has responded well to treatment with mycophenolate mofetil and hydroxychloroquine and was successfully weaned off of prednisone…
Rheumatologist Richard M. Pope, MD, Was Honored at Northwestern University Symposium
When the head of the division steps down, how do you mark that event? The Feinberg School of Medicine, Northwestern University-Chicago hosted a day-long symposium to honor Richard M. Pope, MD, who had been chief of the division for 27 years, according to Harris Perlman, PhD, the new chief of the Division of Rheumatology. Richard…
Rheumatology Drug Updates: Ixekizumab Improves Work Productivity, plus Vobarilizumab Completes Phase 2 Trial in Rheumatoid Arthritis
Ixekizumab Improves Work Productivity in Patients with Plaque Psoriasis Indirect costs of reduced work productivity can have a significant impact on a patient’s quality of life. A recent article published in JAMA Dermatology analyzed the results of three multicenter, randomized double-blind Phase 3 trials, UNCOVER-1, UNCOVER-2 and UNCOVER-3, which evaluated the effect of ixekizumab on…