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…
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…
On July 1, 2015, the Rheumatology Research Foundation awarded more than 80 grants to a wide range of rheumatology trainees and professionals. The recipients, who submitted applications in 2014, will receive funding for essential education and training, as well as innovative research projects. Their applications were closely examined by experts in different areas of the…
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…
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…
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…
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…
Dr. Sheffield is an adult rheumatologist who received the following referral request from a family doctor: “Please see this 22-year-old male with a history of juvenile arthritis for ongoing care. I have only seen him once, and have no previous medical records.” Dr. Sheffield meets with Paul, who reports that he has had arthritis since…
In late March 2012, I awoke with pain in my left hand. I had difficulty moving my metacarpophalangeal (MCP) joints. They did not move smoothly, but clunked. As I repeatedly attempted to open and close my hand, I realized that I had morning stiffness. As the pain and stiffness gradually improved over the next hour,…