Sir William Osler, the father of modern medicine, said “the desire to take medicine is perhaps the greatest feature that separates man from animal.” Determination of the benefit of a medication can be challenging and includes a number of factors, such as pharmacologic activities on the disease pathophysiology, pharmacokinetic properties and patient characteristics.1,2 An additional,…
Immune checkpoint inhibitors (ICIs) are at the forefront of advances in cancer therapy and have shown promising results for progression-free survival. Checkpoint signaling pathways, such as cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1), normally regulate the immune response to promote self-tolerance and prevent tissue damage and inflammation. PD-1 is a…
Studies highlighting the large numbers of people affected by knee osteoarthritis (OA) point to what clinicians who treat knee OA have been seeing for the past few decades: a substantial increase in the prevalence of knee OA in the U.S. and globally. Roughly 250 million people are affected by knee OA worldwide, and about 14…
A 36-year-old woman presented at the Johns Hopkins Arthritis Center for a second opinion regarding a diagnosis of psoriatic arthritis (PsA). One year prior to our evaluation, she had developed pain and stiffness in her hands, feet, knees, ankles, elbows and shoulders. She had mild plaque psoriasis of the scalp and base of the neck,…
As a first-year internal medicine resident, I find myself consulting rheumatologists for just about every mystery patient in our hospital. Like many residents, I was initially intimidated by the complexity of this elusive field. At first glance, diagnosis and management seem completely inaccessible to a first-year resident. But several rheumatology consults later, I can confidently…
As rheumatology professionals, we focus on how to achieve better outcomes for our patients: lower disease activity, remission, milder symptoms and prevention of joint damage or serious complications, such as heart disease. Another outcome is just as important: good quality of life. What can we do to engage our current patients and those at risk…
Chikungunya is among a group of 16 diseases transmitted through mosquito, tick or flea bites that is of increasing public health concern in the U.S. Although few rheumatologists are likely to diagnose patients with the acute phase of the disease, they may encounter a handful of patients each year who complain of persistent, and often…
Save the date for the 2018 ACR/ARHP Annual Meeting, Oct. 19–24 in Chicago. Connect with your colleagues for an unmatched educational experience featuring exceptional sessions by leading rheumatology experts. The ACR/ARHP Annual Meeting is your gateway to global rheumatology education. With more than 450 sessions—including The Great Debate—the meeting provides boundless opportunities for professional development,…
Take the challenge. CPT codes: 99203/99243 ICD-10: M25.521, M25.522, M25.561, M25.562 History—Comprehensive: The history of present illness is extended, the review of systems is complete, and the past medical, family and social history are documented. All three of the HPI, ROS and PFSH are needed to achieve the history level as comprehensive. Examination—Detailed: This level…
A 55-year-old female patient with pain in multiple joints is referred to the office by her primary care physician. She complains of pain in both knees and both shoulders. She rates the pain at 7 on the pain scale. Her pain is worse at night after she gets off work. Soaking in her hot tub…