(Reuters)—Johnson & Johnson’s blockbuster psoriasis drug ustekinumab (Stelara) led to a significant reduction in disease activity in patients with systemic lupus compared with a placebo in a midstage clinical trial, according to data released on Nov. 4. Ustekinumab is already approved for psoriasis, psoriatic arthritis and Crohn’s disease and had third-quarter sales of $1.12 billion….
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Unwise Choices: EHRs, PBMs, Drug Costs Are Leading to Physician Burnout
My dear electronic health records How do I dislike thee? Let me count the ways Adaptation of Sonnet 43 By Elizabeth Barrett Browning, 1806–1861 As my tenure as physician editor winds down, it’s worth reviewing some of the more nettlesome issues confronting clinicians that have been previously discussed in these pages and gauge their current…
Rheumatologists Find Nailfold Capillaroscopy an Increasingly Useful Diagnostic Tool
Interest in viewing the nail capillaries dates to the late 17th century. Later research by Maurice Raynaud and others in the late 19th and early 20th century first established a direct link between the nailfold capillaries and certain medical conditions. Although underutilized in the past, with the advent of modern digital equipment and the validation…
How Juvenile Idiopathic Arthritis Affects Patients, Families
After having had juvenile idiopathic arthritis (JIA) for 20 years, I had a moment in my journey when I realized something new: “Your arthritis doesn’t just affect you, you know,” my sister said. This statement stopped me in my achy tracks. For two decades, I had been operating under the assumption that JIA was my…
Heated Gloves May Improve Hand Function in Diffuse Systemic Sclerosis
Systemic sclerosis (SSc), a subtype of scleroderma, is a rare, complex autoimmune disease characterized by widespread vasculopathy of the small arteries and fibroblast dysfunction.1,2 It has been described as a fibrosing microvascular disease, because vascular injury precedes and leads to tissue fibrosis.3 The resulting Raynaud’s phenomenon, pain, skin thickening and tightening, and multi-organ involvement have…
Autoreactive Germinal Centers: A Single Autoreactive B Cell Clone Can Drive Autoimmunity
A study in mice provides insight into the maturation of the self-reactive B cell response, contextualizing the epitope spreading observed in autoimmune disease. Researchers found that clonal expansion of wild type B cells in autoreactive germinal centers appeared to be at the heart of epitope spreading and the consequent autoimmune response…
Clinical Thought Process for Proper Medical Decision Making, Part 2
In Part 1 of this series, we covered the vital role of medical decision making in determining the final level to bill for a patient encounter. Medical decision making is the key component in coding because it reflects the intensity of the provider’s cognitive labor. This implies that there’s an unseen component involved in the…
Hemoptysis in a Young Indian Male
A 22-year-old Indian male presented to the emergency department with hemoptysis. A month prior, he had presented to an urgent care center complaining of cough with occasional episodes of blood-tinged sputum in the morning. He was diagnosed with community-acquired pneumonia based on a chest X-ray without laboratory testing and was prescribed levofloxacin. A few days…
When Is a Doctor Too Old to Practice?
Steady hands, nerves of steel: The endoscopic transphenoidal hypophysectomy is a delicate neurosurgical procedure. Using a three-dimensional microscope and a powerful magnetic resonance imaging machine to guide them, the surgeon must meticulously dissect the throat tissues, navigate through the palate and the sinuses to reach the base of the skull where the pea-sized master gland,…
Ibuprofen More Likely to Raise BP than Naproxen or Celecoxib
NEW YORK (Reuters Health)—Ibuprofen boosts blood pressure (BP) more than naproxen or celecoxib in patients who take non-steroidal anti-inflammatory drugs (NSAIDs) to treat arthritis, according to a new substudy from the PRECISION trial. “These drugs are different with regard to BP, and ibuprofen is the worst,” Dr. Frank Ruschitzka of University Hospital Zurich in Switzerland,…
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