I have been following with interest all the discussions about the new Medical Home (aka, the Patient Centered Medical Home) concept. This is our silver bullet that will improve patient access, raise quality levels, increase overall satisfaction and save billions of healthcare dollars - all at the same time!
Obesity is a modifiable risk factor for knee osteoarthritis (OA). Weight loss may reduce the risk of knee OA, and increased levels of physical activity may result in improvements in disability-related outcomes. However, intensity of physical activity is not as important in weight loss as total energy expended.
Pulmonary arterial hypertension (PAH) may lead to increased pulmonary vascular resistance, compromised vasoreactivity, right heart failure, and death. PAH, a subset of pulmonary hypertension (PH), classically is associated with systemic sclerosis but also occurs with other rheumatologic conditions. Early diagnostic strategies are essential. The symptoms of PAH often are nonspecific; the most common presenting symptom is dyspnea.
Older patients experience shoulder pain more frequently than younger patients and present with different issues. Using a combination of tests with a detailed history is the best approach to narrowing the differential.
Contrary to earlier reports, mineralization of articular cartilage is a common event in end-stage osteoarthritis (OA) and is closely associated with disease progression. There is a significant correlation between clinical symptoms and the amount of mineralized cartilage.
The jump protocol with analysis of time to stabilization (TTS) can discriminate between persons with and those without functional ankle instability (FAI), according to researchers in the Department of Sport and Exercise Science at the University of Auckland in New Zealand. Persons with FAI have delayed trunk muscle reflexes to a sudden perturbation, supporting theoretical and experimental descriptions of proximal adaptations associated with ankle injury.
A new network from the University of Alabama at Birmingham (UAB) will create a national database that aims to see how rheumatoid arthritis (RA) patients respond to different RA drugs, and then use that information to further personalize RA treatment.
Among the numerous posters on display under the "Fibromyalgia and Soft Tissue Disorders" heading on day 4 at the American College of Rheumatology/Association of Rheumatology Health Professionals 2009 Annual Scientific Sessions were posters focused on the development of a fibromyalgia (FM) responder index, anxiety and depression among patients with FM, tai chi as an effective treatment of FM, and sex differences in predictors of increased symptoms after exercise and sleep restriction in patients with such chronic pain disorders as fibromyalgia.
Dozens of posters were presented under the RA umbrella during the morning of day 4 at the American College of Rheumatology/Association of Rheumatology Health Professionals 2009 Annual Scientific Sessions.
Dozens of posters were presented under the "Fibromyalgia and Soft Tissue Disorders" umbrella during the morning of day 4 at the American College of Rheumatology/Association of Rheumatology Health Professionals 2009 Annual Scientific Sessions. Among the highlights are the following.
The 2009 American College of Rheumatology/Association of Rheumatology Health Professionals Scientific Meeting will feature several “Curbside Consult/Ask the Professors” sessions. Designed to feature information and discussion about “difficult management decisions that must be made in the absence of strong data,” these sessions give attendees the opportunity to “compare their personal management approaches” to the clinical problems outlined in the featured vignettes and scenarios with those of “the academic expert consultants and other clinicians in the audience.”
A new study finds that pindolol is highly effective for the treatment of fibromyalgia symptoms manifesting themselves through the autonomic nervous system.
Researchers examining senior-identified arthritis management strategies were able to identify the most helpful treatment methods as well as the biggest challenges preventing most seniors from engaging in these practices.
Despite findings from other studies indicating that somnolence is a sometimes significant adverse effect in pregabalin use, this study suggests that it is statistically insignificant.
RA patients identified through the Department of Veteran Affairs national administrative databases that were on anti-TNF therapy had a higher risk of developing non-melanoma skin cancer than those on non-biologic DMARDs.
Fibromyalgia syndrome (FMS) is characterized by widespread chronic pain and tenderness. Persons with FMS are a diverse population, with widely variable symptom presentation and severity, as well as secondary symptoms. Because the symptoms are so diverse, diagnosis and management become challenging. Mounting evidence supports altered CNS processing of nociceptive stimuli as a mechanism.
As the population ages and persons live longer with more medical comorbidities, the incidences of both gout and pseudogout will continue to increase. Uric acid metabolism is crucial to the pathogenesis of gout. Patients who have the arthritis associated with crystal-deposition disease typically present clinically with acute attacks of joint pain, swelling, and erythema and have asymptomatic periods between acute attacks.
Clinical study findings of recent years support the notion that patients with rheumatoid arthritis (RA) should be treated earlier and more aggressively. Monotherapy with disease-modifying antirheumatic drugs (DMARDs) is effective in some cases, but triple DMARD therapy is superior to double therapy or monotherapy in early or late RA. Leflunomide is at least as effective as methotrexate (MTX) and sulfasalazine and more effective than placebo.
A disruption in any part of the vitamin D physiological pathway can result in vitamin D deficiency, which may lead to bone pain, muscle weakness, falls, low bone mass, and fractures.
A pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare soft tissue lesion that mainly affects superficial soft tissue in the lower extremities. PHAT is classified as a borderline/intermediate-grade soft tissue tumor because of the substantial risk of local recurrence.
The severity scores of dyspepsia symptoms and dyspepsia-related quality of life disturbance are higher in patients with fibromyalgia syndrome (FMS) than in patients with rheumatoid arthritis (RA) and in healthy persons.
Sustained disease-modifying antirheumatic drug (DMARD)-free remission occurs in about 10% of patients with rheumatoid arthritis (RA). It can be predicted by several clinical variables that are assessed routinely in outpatient clinics.
Reduced toe flexor strength and the presence of toe deformities increase the risk of falling in older persons, according to researchers at the Biomechanics Research Laboratory, University of Wollongong, in Australia
An 81-year-old man with had a one-year history of right knee pain that had worsened in recent weeks despite no trauma or injury. What does the X-ray show?
An 84-year-old woman presented with pain and swelling in her knees and hands. She had a history of severe psoriasis and osteoarthritis. How can you make a differential diagnosis when OA may coexist with rheumatoid arthritis, psoriatic arthritis, OA, and crystal arthritis? Read on to find out.
The precautionary recommendations for the H1N1 (swine) flu in persons with lupus currently are not different from those for the general public, according to the Lupus Foundation of America (LFA). However, because persons with lupus often are at increased risk for infections, especially if they are taking immunosuppressive agents, they should be particularly vigilant about taking the generally recommended precautions.
Although many medications are used for the management of systemic lupus erythematosus (SLE) and its complications, only aspirin, corticosteroids, and the antimalarial drug hydroxychloroquine (HCQ) are specifically approved by the FDA.1 Most other medications used for SLE treatment are commercially available off label (Table 1), usually borrowed from cancer or transplant regimens. In some cases, medications have been approved for a specific clinical manifestation seen in both idiopathic disease and SLE, such as bosentan for pulmonary hypertension.
The name and identifying features derive from what happens to the skin: it becomes thickened and swollen from deposition of excessive amounts of collagen.
The impact of biomechanical factors on rheumatoid arthritis (RA) has gained increased attention from researchers, as evidenced by studies reported in Clinical Biomechanics. For example, reevaluating knee kinematics over time is important in patients with RA who wear a mobile-bearing total knee prosthesis, according to investigators at the Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
ABSTRACT: Pay for performance (P4P) is causing physicians to examine how they provide care individually and collectively within local health systems. It is the most recent attempt by Medicare and commercial payers to reduce the cost and improve the outcomes of health care. Understanding P4P and deciding how to manage the multiple programs being implemented by payers will challenge physicians' ethics and practice resources. Improving health care for musculoskeletal diseases will require cooperation among the specialties that share responsibility for this care and improved methods for coordinating and documenting it. (J Musculoskel Med. 2009;26:207-212)
