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Coding Corner Question: Is This Shoulder Ultrasound Billable?

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A 32-year-old male patient with rheumatoid arthritis affecting multiple joints without rheumatoid factor returns to the office for a follow-up visit with the nurse practitioner (NP). The patient states his overall pain has improved since his previous visit, although he rates the severity of his right shoulder and right wrist pain at a 5 on…

Study Says Sjögren’s Patients Have a High Specificity for a Novel Antibody

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An antibody previously un-recognized in patients with Sjögren’s syndrome may shed new light on the patho­physiology of one of the most troubling and disabling symptoms in many of these patients. Investigators at Johns Hopkins University, Baltimore, found the anti-calponin 3 antibody had a high specificity for Sjögren’s syndrome, particularly among patients with neuropathies.1 “There is…

Study Finds Chronic Opioid Use Doubled in Rheumatoid Arthritis Patients

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The prevalence of chronic opioid use among patients with rheumatoid arthritis (RA) doubled between 2002 and 2015, especially among patients with severe pain or on antidepressants, according to a new study.1 The study adds to prior data reporting trends in chronic opioid use in RA patients.2,3 Severe pain was the strongest predictor for use of…

Do a Lack of Information & Social Support Affect Lupus Outcomes?

Renée Bacher   |  

Patients with systemic lupus erythematosus (SLE) need better appraisal and more informational and social support, according to a new study on health-related quality of life in these patients.1 The phenomenological study, comprising qualitative interviews with patients in the Lupus Clinic at the Washington University School of Medicine, St. Louis, Mo., also found a need for…

Case Report: Diagnosing, Treating Hepatitis B-Linked Polyarteritis Nodosa

Naveen Raj, DO, & Lisa Duncan, MD   |  

Hepatitis B virus (HBV) associated polyarteritis nodosa (PAN) is an increasingly rare vasculitis in developed countries due to advances in HBV vaccination and antiviral therapy. However, the condition does persist, and rheumatologists should consider it when evaluating vasculitis cases. Below, we discuss a case that illustrates the varied clinical presentations PAN can encompass. A high…

Case Report: Does a Rapid-Onset Neck Mass Have Rheumatic Origins?

Tej Bhavsar, MD, & Nancy Joste, MD  |  

A 54-year-old African American man arrived at the emergency department with the acute onset of a tender mass on the left side of his neck. It had been getting progressively larger for the preceding two days. History & Examination His history included chronic right hip osteoarthritis with two surgeries performed five years prior. At his…

Light micrograph of a vascular lesion (center) caused by systemic sclerosis.

Case Report: Can Salt-&-Pepper Skin Mean Systemic Sclerosis?

Wesam Gouda, MBBCh, MSc; Abdelhafeez Moshrif, MBBCh, MSc, MD; Fatma H. El Nouby, MBBCh, MSc, MD; & Amal Fehr, MBBCh, MSc, MD  |  

Systemic sclerosis (SSc) is a multi-system connective tissue disease in which skin and internal organ fibrosis are associated with an obliterative micro-vasculopathy and a degree of inflammation.1 Patients often report it takes one to three years from the appearance of the first signs and symptoms before they receive a diagnosis. The signs and symptoms of…

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Tips for Diagnosing Metabolic Myopathies

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When evaluating patients with possible myopathic symptoms, rheumatologists must consider a rare, but important, group of inherited disorders: the metabolic myopathies. However, their diagnosis often remains a challenge. Early recognition of these primary metabolic myopathies is essential to help prevent disease morbidity and mortality from rhabdomyolysis. Here, we focus on the metabolic myopathies that present…