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Rheumatology Coding Corner Question: Gout Visit for Established Patient

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A 55-year-old female patient returns to the office with complaints of gout pain. She is complaining of swelling and a burning pain in her left toe. She has been taking an over-the-counter NSAID to treat the pain, but this has done little to alleviate it. This is her second flare this year. The patient denies…

FDA Approves Ustekinumab for Crohn’s Disease

Reuters Staff  |  

(Reuters)—Johnson & Johnson says on Monday that the U.S. Food and Drug Administration approved the company’s psoriasis drug, ustekinumab (Stelara), for use in adults with Crohn’s disease. The drug is approved in the U.S. to treat plaque psoriasis and a type of arthritis associated with psoriasis. Crohn’s is a chronic inflammatory condition in the gastrointestinal…

Why Rheumatologists Should Care about Zika: How It’s Transmitted & Spreading in the U.S.

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Rheumatologists are already familiar with one mosquito-borne virus, chikungunya, whose presentation mimics arthritis. Now, with its recent spread to Puerto Rico and the Southeastern U.S., Zika, another mosquito-borne virus, has become an international public health concern. Sexual transmission of the virus was recently confirmed, expanding the virus’s threat…

Corticosteroid Use in Acute Polymyalgia Rheumatica Should be Reassessed

Arthur E. Brawer, MD  |  

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…

Blacks, Asians at Higher Risk for Allopurinol-Related Skin Reactions

Deborah Levenson  |  

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…

Rheumatology Coding Corner Question: Level 4 New Patient Visit

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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…

New Criteria Released for Macrophage Activation Syndrome in Juvenile Idiopathic Arthritis

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Although most systemic juvenile idiopathic arthritis patients don’t develop macrophage activation syndrome (MAS), the approximately 10% who do have this serious complication can experience widespread, massive inflammation, debilitating symptoms and even death. To improve understanding of MAS among physicians and advance efforts to develop effective therapies to treat it, a panel of 28 international pediatric…

Rheumatology Coding Corner Question: Physical Examination with Infliximab Infusion

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A 12-year-old male established patient with inflammatory bowel disease with associated juvenile spondyloarthropathy returns to the office for a follow-up visit for his infliximab infusion. The patient reports moderate pain in his right hip after walking for extended periods of time or after sports activities. He denies any other joint pain and denies any joint…

Rheumatology Case Report: Concomitant Lupus with Features of Scleroderma, Castleman Disease

Kwabna Parker, MBBS, Sireesha Datla, MD, & Nancy Soloman, MD  |  

We report a case of a 27-year-old woman who was initially diagnosed with systemic lupus erythematosus (SLE), had features of scleroderma and was subsequently found to have lymph node biopsy consistent with multicentric Castleman disease (MCD). She also had serologic evidence of acute Epstein-Barr virus (EBV) infection (vs. reactivation of EBV). The occurrence of MCD…