A 51-year-old man with a history of limited systemic sclerosis with Raynaud’s phenomenon and pulmonary hypertension being treated with tadalafil and macitentan presented to a clinic with ulceration of his right pinkie. The patient had injured the finger two months earlier. He reported poor healing and the presence of a persistent ulcer since the injury….
Ultrasound may provide unique insights into the effects of immune checkpoint inhibitors on the human body beyond the immune system. Research suggests synovitis and inflammatory tendon involvement are commonly seen in patients with immune checkpoint inhibitor-induced inflammatory arthritis.
A 27-year-old, left-handed man was referred to our ultrasound clinic for left elbow pain. History The patient had been a pitcher on a Minor League Baseball team. Two years before, he developed sudden, severe medial elbow pain while pitching in a game. The pain was associated with some tingling down the left medial forearm. The…
For most rheumatologists, the key elements of the physical exam—inspection, palpation, percussion and auscultation—have long been second nature, but a fifth modality has grown in importance with respect to making the correct diagnosis: ultrasound. From evaluating for Doppler signal and additional findings indicative of synovitis to identifying bony erosions, chondrocalcinosis, tophi and other articular and…
A 65-year-old woman was referred by an orthopedist to a rheumatologist for left knee pain. Previously, in 2014, she underwent left total knee arthroplasty (TKA) for severe osteoarthritis in a different institution. Following the procedure, she experienced severe chronic anterolateral knee pain at rest, exacerbated by walking. Because she was rendered wheelchair bound and required…
ATLANTA—Two ways to investigate injuries to the upper extremities are by in-depth physical examinations and ultrasound. In a Clinical Practice session at the 2019 ACR/ARP Annual Meeting, Anatomy: Correlating Physical Exam and Ultrasound in Common Sports Injuries of the Upper Extremity, Carlin Senter, MD, FACP, associate professor of primary care sports medicine at the University…
NEW YORK (Reuters Health)—Ultrasound guidance does not improve the effectiveness of treat-to-target therapy in rheumatoid arthritis (RA), new findings confirm. “Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy,” Dr. Ulf Sundin of Diakonhjemmet Hospital, Oslo, and colleagues write in Rheumatology….
Take the challenge. Answer: No, if billed as incident-to for the NP. Note: The patient’s current insurance carrier is Blue Cross Blue Shield of Massachusetts (BCBS of MA). Under BCBS of MA, nurse practitioners and nurse practitioner primary care providers are not allowed to perform or interpret radiology services. Therefore, the physician would have to…
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…
I have worked as an advanced practice provider (APP) in pediatric rheumatology for nearly 16 years. My collaborating physicians have allowed me to function to the full extent of my scope of practice while allowing me to develop professionally within the subspecialty. My latest endeavor has been learning how to perform musculoskeletal ultrasound (MSUS) and…