Dr. Box is proud to announce the opening of Carondelet Rheumatology, a Division of Signature Medical Group. Since 1993 Dr. Box has been serving Rheumatology patients on the St. Joseph/Carondelet campus, and is thrilled to continue to do so. Over the years Dr. Box has partnered with other Physician groups and is now practicing independently as his own division. Dr. Box is Board Certified in Rheumatology as well as Internal Medicine and very active in various charitable foundations throughout the city. He is the President of the Midwest Rheumatology Association, and serves on the Board of Directors for the Arthritis Foundation of Kansas City, and the Coalition of State Rheumatology Organizations. Dr. Box works with patients that are affected by inflammatory and autoimmune disorders. He is also involved in Clinical Research studies that ultimately shape future treatment options for his patient population.
Rheumatology is the study, diagnosis and treatment of diseases that affect the muscles, joints and bones.
There are more than 200 rheumatic diseases and syndromes and many of these conditions are considered autoimmune diseases. Autoimmune diseases ensue from an abnormal response of the body’s immune system against its own tissues. Over 45 million people in the US are coping with some type of rheumatic disease.
A rheumatologist is a physician who diagnoses and treats diseases that affect the muscles, joints and bones. Accredited rheumatologists have earned a bachelor’s degree and a 4-year medical degree, as well as completed three years of an internship or residency program followed by a 2- or 3-year fellowship in rheumatology.
Typically, you would visit your primary care doctor or internist if you experience pain in your joints, muscles or bones. Your internist may prescribe medication to resolve the issues. If the condition persists after the medication is completed then your internist may refer you to a rheumatologist for an evaluation. This is especially true, if you have a family history of autoimmune or rheumatic diseases. Other times to visit a rheumatologist are:
Every appointment is specialized to the person, but the following should give you a good idea of what to expect at the first visit to a rheumatologist.Prior to your appointment
During your appointment
You will be asked lots of questions about your pain, past diagnoses, past treatments, your lifestyle, etc. Be prepared to share a list of the following:
Infusion therapy provides patients with medication intravenously (IV). It is safe and effective for patients who have a severe condition that has not been managed by oral medications or if oral medications are not an option.
Infusion therapy is offered in a comfortable setting within Carondelet Rheumatology.
You will be seated in a comfortable recliner during the therapy. You can nod off during the procedure or you can pass the time with a book, magazine, smart phone computer or ipad.
Medicare and most health insurance plans cover this type of therapy. We would be happy to contact your insurance company to determine your coverage.
RA is a chronic inflammatory form of joint disease. It is an autoimmune disease meaning that the body’s immune system attacks its own joints causing swelling, pain and redness. Over time, the prolonged periods of inflammation can cause destruction of the joints and deformities.
The onset of the disease can happen at any age, but RA typically occurs in people between the ages of 30 to 50 years old. The disease is more common in women. About 70% of people with RA are women.
RA symptoms include joint pain, swelling and stiffness as well as fatigue and muscle pain. The symptoms can vary considerably from person to person including the location of the symptoms and the severity.
Typically, symptoms of RA progress slowly. Initially, symptoms may flare up and then improve all by itself. Because of this, people often hesitate to call a doctor or rheumatologist. Please note that it is important to treat RA as soon as possible because RA can lead to long term and irreversible joint damage and even damage major organs including your heart.
As a systemic disease, RA can affect multiple organs and systems in your body. Patients can experience fever, weight loss, fatigue, malaise, enlarged lymph nodes, carpal tunnel syndrome and in more dramatic cases inflammation of the tissue around the heart (pericarditis), eye inflammation and lung disease.
Most patients with RA have both wrists and the small joints of the hands and fingers involved, and frequently the feet, toes and ankles. That being said, it’s important to keep in mind that any joint in your body can be affected by RA. As the disease progresses, larger joints such as elbows, shoulders, hips and knees can become affected. Interestingly, RA typically develops in the same joints on both sides of your body.
Despite ongoing research, the etiology of RA remains unknown. It’s thought to be caused by different factors such as genetics, environment (smoking, silicon, poor dietary habits and others). Some viruses (EBV and Parvo B19) have also been considered as possible triggers.
There are two antibodies that are present in most patients with RA, they’re called rheumatoid factor and anti-CCP. Unfortunately, some patients who have the disease, do not have the antibodies in the blood.
Usually, your doctor will check two inflammatory markers in the blood, ESR (erythrocyte sedimentation rate) and CRP ( C-reactive protein). When elevated, these numbers indicate that the disease is active. There also other tests, such as VECTRA, that in addition to ESR/CRP will measure other proteins that indicate inflammation.
Sometimes, it’s possible to identify bone destruction by an X-ray of patients with RA. Early diagnosis and treatment are crucial to prevent bone erosions.
While there is no cure for RA, there are many safe and effective options to prevent disease progression and joint destruction. There is a class of medications called DMARDs (disease modifying agents), that are usually used as a first line of defense and depending on your response a biologic medication can be added. These medications are immune modulators that will try to stop your immune system from destroying your joints. Initially you may be placed on oral steroids to calm down the inflammation, until the long-term plan is in place. Discuss your options with your rheumatologist.
A rheumatologist is typically the most qualified to provide an early and accurate diagnosis of RA and to create an effective treatment plan.
Rheumatologists are internist with specific training and experience in the diagnosis and treatment of musculoskeletal diseases and autoimmune conditions, like RA.
After four years of medical or osteopathic education and three years of residency in internal medicine, a doctor who wants to concentrate on rheumatology needs to complete a two year rheumatology fellowship and pass a test to become board certified.
Osteoporosis means “porous bone” and is characterized by the weakening of your bones, causing them to become fragile and breakable at the slightest bump or fall. While osteoporosis can affect men and women, women are four times more likely to develop this disease, especially after menopause. It is a considered a silent disease because there are no warning signs or symptoms. Treatment for osteoporosis includes medication, exercising, eating a balanced diet and consuming plenty of calcium and Vitamin D.
Lupus is a chronic autoimmune inflammatory disease that affects over 1.5 million Americans. With lupus, the immune system cannot differentiate between a foreign body and healthy tissue, and thus attacks the healthy tissue in addition to the foreign body. Inflammation, fatigue, swelling of the joints and headaches are symptoms of lupus. Doctors typically prescribe an anti-inflammatory medication and corticosteroids to help alleviate the symptoms.