About a year ago, I stuffed all my earthly belongings into my black Volkswagen Jetta and set out on a 10-hour interstate journey. I had just graduated from residency at the University of Kentucky and was headed westward, to Iowa City, for a fresh start as a rheumatology fellow. During the 10 hours I spent…
Search results for: joint pain
Rheumatology Coding Corner Question: Office Visit for Chronic Idiopathic Gout
Follow-up Visit with Time A 62-year-old male patient returns to the office for a follow-up visit for chronic idiopathic gout without tophi. The patient’s present uric acid level is 4.0, and he is now taking allopurinol 450 mg per day. Previously, he was taken off indapamide due to an increase in his uric acid. He…
Prepare NOW for ICD-10 Medical Coding Transition
The ICD-10 page on the Centers for Medicare & Medicaid Services (CMS) website features a countdown clock that shows the time left until Oct. 1, 2015, the date on which compliance with the new code set becomes mandatory. By the time this issue goes to press, the clock will read 90 or fewer days. Time…
The ACR’s State-of-the-Art Clinical Symposium: Rheumatologists Weigh in on Tough-to-Treat Cases, Paget’s Disease, Imaging
CHICAGO—A 49-year-old woman has had RA for eight years. She has a rheumatoid factor reading of 35, an aCCP reading of 160, erythrocyte sedimentation rate of 42, plus erosions. She has been on methotrexate. She tried etanercept for six months, but then it stopped working. She was on 40 mg of adalimumab weekly, but it…
The ACR’s State-of-the-Art Clinical Symposium: Experts Discuss Jakinibs, Osteoarthritis, Membranous Lupus Nephritis
CHICAGO—With the approval of the Jak inhibitors (i.e., jakinibs) tofacitinib and ruxolitinib—and others being investigated—rheumatologists need to arm themselves with an understanding of these drugs so they can think critically when evaluating them and deciding how to use them, said John O’Shea, MD, chief of the Molecular Immunology and Inflammation Branch of and scientific director…
Rheumatology Coding Corner Question: Sacroiliac Injection with Office Visit
Coding for SI Injections with Office Visit A female patient previously diagnosed with sacroiliitis and ankylosing spondylitis returns to the office for a follow-up visit. The patient reports her lower back has been stiff and swollen for the past couple of weeks. She is currently on celecoxib and ranitidine, and mentions that she had some…
Inspiratory Muscle Training Boosts Lung Strength in Ankylosing Spondylitis
NEW YORK (Reuters Health)—Inspiratory muscle training can help improve aerobic capacity and pulmonary function in patients with ankylosing spondylitis (AS), according to new findings presented at the European League Against Rheumatism Annual Congress. “Inspiratory muscle training as a stand-alone therapy improves inspiratory muscle function (strength and endurance), decreases symptoms of dyspnea and improves exercise capacity,”…
Eosinophilia: A Diagnostic Evaluation Guide for Rheumatologists
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…
Tips for Treating Insomnia in Rheumatology Patients
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,…
How Celebrities, Senators, Dietary Supplements Muddle Medicine
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…
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