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…
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FDA Approves Ustekinumab for Crohn’s Disease
(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…
Research on Ixekizumab in Psoriatic Arthritis and More Presented at EULAR 2016
LONDON—Results from the extension phase of a Phase 3 trial for the IL-17A inhibitor ixekizumab in psoriatic arthritis (PsA) show that patients started on placebo, adalimumab and ixekizumab continued to show improvements in arthritis, dactylitis and ethesitis, said Philip Mease, MD, a rheumatologist at Swedish Medical Center University of Washington in Seattle.1 Dr. Mease presented the…
Pain Linked to Inflammatory Lesions in Knee Osteoarthritis
Inflammation in the knee was found to be associated with development of pain sensitization in recent research with a cohort from the Multicenter Osteoarthritis Study (MOST). This research finding may indicate that targeting of inflammation could help reduce pain severity in knee osteoarthritis (OA). Tuhina Neogi, MD, PhD, says that her and her colleagues’ research,…
When Medical Workforce Grievances Lead to Strikes
Picket Lines: June 27 was marked on my calendar as the day to watch. No doubt the union organizers shrewdly selected it to be their strike day because of its proximity to July 1, an auspicious date for teaching hospitals, when rookie interns and residents anxiously assume their heightened roles of responsibility within the medical…
Corticosteroid Use in Acute Polymyalgia Rheumatica Should be Reassessed
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…
New Research into Rheumatoid Arthritis, Gout Includes Updates on Methotrexate, Biologics, Ultrasound
LONDON—From optimizing responses to methotrexate, to the efficacy of biologics, to the need for imaging in assessing remission, the literature, as ever, has been lively with explorations of pressing topics in the treatment and management of rheumatoid arthritis. Josef Smolen, MD, chair of rheumatology at the Medical University of Vienna, reviewed many of the highlights…
Rheumatoid Arthritis Patient Shares Lessons Learned from Breaking Leg in a Fall
Humpty Dumpty sat on a wall Humpty Dumpty had a great fall All the king’s horses and all the king’s men Couldn’t put Humpty together again. —Mother Goose I feel like a female Humpty Dumpty. Recently I took a great fall, and now I am in the process of being put together again. I was…
Rheumatology Coding Corner Question: Level 4 New Patient Visit
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…
When Rheumatologists Are a Patient’s Second or Third Choice for Medical Opinion
Outside Exam Room No. 5, the chart rack was empty, so I assumed my new consult was late. Just in case, I looked back over my shoulder as I passed by the partially open door and glimpsed the lower half of a woman holding a three-ringed binder on her lap. I squinted and took a…
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