CHICAGO—A 49-year-old woman has had RA for eight years. She has a rheumatoid factor reading of 35, an aCCP reading of 160, erythrocyte sedimentation rate of 42, plus erosions. She has been on methotrexate. She tried etanercept for six months, but then it stopped working. She was on 40 mg of adalimumab weekly, but it…
There can be a rhythm to rheumatology. At least that’s what Alain Alvarez, MD, can sometimes find. Listening, assessing, helping. It can be a successful dance when doctor and patient become partners, hoping to lead each other forward. When you consider this, it might be little surprise that Dr. Alvarez is also a dance teacher….
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History A 56-year-old man with end-stage renal disease on peritoneal dialysis presents…
View the question. Findings/Diagnosis The AP radiograph of the left shoulder (see Figure 1) shows erosions of the proximal humeral and glenoid articular surfaces (black arrows) without joint-space narrowing. There is a well-defined marginal erosion with overhanging edge at the junction of the proximal humeral articular surface and rotator cuff insertion on the greater tuberosity (ellipse)….
Coding for SI Injections with Office Visit A female patient previously diagnosed with sacroiliitis and ankylosing spondylitis returns to the office for a follow-up visit. The patient reports her lower back has been stiff and swollen for the past couple of weeks. She is currently on celecoxib and ranitidine, and mentions that she had some…
CPT codes: 99214-25, 27096, J3301 x1 ICD-9: 720.2, 720.0, 787.02 ICD-10: M46.1*, M45.9*, R11.0 This encounter is coded as 99214 because it includes: Detailed history; Comprehensive examination—eight systems counted; and Medical decision making—moderate complexity (established problem, new problem with no additional workup; new prescription drug ordered). Keep in mind, the CT guidance is an inclusive…
Full disclosure: I am not a rabid fan of dogs. None rank among my best friends. Perhaps my antipathy stems from a memorable childhood event, when I was chased down the street where I lived by a neighbor’s large and not-so-friendly hound. He seemed to be twice my size, and this explains why I may…
After completing a 10-year clinical trial examining treatment strategies for rheumatoid arthritis, Dutch researchers used a questionnaire to determine the study conditions and individual motivators that kept 60% of patients participating long term…
(Reuters Health)—People with chronic pain may be able to use online tools to manage their symptoms, lessening the need for frequent doctor visits, an Australian study suggests. Researchers tested a series of web-based pain management tutorials on a group of adults who had been suffering symptoms for more than six months. Regardless of how much…
NEW YORK (Reuters Health)—Screening for celiac disease (CD) is important in patients newly diagnosed with type 1 diabetes (T1D) and in children presenting for rheumatology evaluation, according to a pair of new reports. In a systematic review, online June 15 in Pediatrics, Australian researchers found most cases of CD are diagnosed within five years of…