EXPERTISE IN RHEUMATOLOGY

What is rheumatology?

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.

Why choose a rheumatologist?

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.

What are the most common conditions treated by a rheumatologist?

When should I go to a rheumatologist?

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:

• When you have been diagnosed with arthritis or a rheumatic disease by your primary care doctor.
• When you are experiencing persistent joint pain and/or swelling.
• When an abnormal blood test shows the presence of a rheumatic disease by testing positive for the following blood tests:
• Antinuclear Antibodies (ANA)
• Erythrocyte Sedimentation Rate (ESR)
• Rheumatoid Factor (RF)
• When your primary care doctor is having a difficult time diagnosing the problem over a period of months or even years.

What should I expect at my first visit to a rheumatologist?

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

• Study your medical family history.  It is an important piece of the puzzle.
• Create a log of your symptoms with the location of the pain, the severity, the day and time of the pain and any changes in the pain.

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:

• Medications you are currently taking with specific doses (Include supplements and vitamins).
• Medications you have tried in the past with specific doses.
• Family medical history.
• Results of prior tests.
• Be prepared to be open and honest.
• The rheumatologist will check you from head to toe looking for indications of inflammation throughout the musculoskeletal system and any rashes, growths, etc.
• The rheumatologist will check your heart, lungs and bowels.
• You will need to bend and flex your joints.
• The rheumatologist may order a blood test, x-rays, MRI, CT scan or ultrasound to assess often difficult to diagnose Rheumatic diseases.

What is infusion therapy?

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.

Where can I get infusion therapy?

Infusion therapy is offered in a comfortable setting within Carondelet Rheumatology.

What conditions can be treated with infusion therapy?

• Ankylosing Spondylitis
• Arthritis associated with Crohn’s Disease
• Gout
• Lupus
• Osteoporosis
• Psoriatic Arthritis
• Rheumatoid Arthritis

What can I expect during infusion therapy?

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.

Is infusion therapy covered by insurance?

Medicare and most health insurance plans cover this type of therapy. We would be happy to contact your insurance company to determine your coverage.

Is infusion therapy covered by insurance?

• ACTEMRA is used for the treatment of rheumatoid arthritis (RA).  Actemra blocks the IL-6. When there is too much IL-6 in the body, an excessive amount of white blood cells are created and they attack the body and joints.  This is only used after an anti-TNF (tumor necrosis factor) medication was been proven unsuccessful.
• BENLYSTA is for adults with active, systemic lupus erythematosus. BENLYSTA is a biologic therapy delivered through an IV infusion. It reduces specific cells in your immune system that can make lupus active. It is used in combination with other lupus medicines.
• BONIVA is a potent bisphosphonate drug used in the prevention and treatment of osteoporosis patients. It works by slowing down bone loss to reduce the risk of fractures.
• ORENCIA treats moderate to severe rheumatoid arthritis by reducing pain and swelling in joints and by preventing further damage to the joints. It also works in children and adolescents with juvenile arthritis.  Orencia has been approved for self-injections, but can be administered in the comfort of our infusion therapy center.
• REMICADE treats moderate to severely active Crohn’s Disease, pediatric crohn’s disease, ulcerative colitis, pediatric ulcerative colitis and rheumatoid arthritis (RA). It is also used for active psoriatic arthritis, ankylosing spondylitis and chronically severe plaque psoriasis. Visit the website to see how it works for each of these conditions or ask our staff.
• RITUXAN is used to treat rheumatoid arthritis (RA) when anti-TNF (tumor necrosis factor) medication treatments have not been successful.  Combined with methotrexate, it can improve symptoms for six months after two infusions.
• SIMPONI ARIA is used to treat rheumatoid arthritis (RA).  People with certain autoimmune diseases have too much TNF-alpha, a protein made by your body’s immune system.  This can cause the immune system to attack parts of the body which can result in pain, stiffness, and swelling.  Simponi Aria targets and binds with excess TNF-alpha, helping to block an underlying cause of the symptoms of RA.

What is rheumatoid arthritis?

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.

Who is at risk for rheumatoid arthritis?

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.

What are the symptoms of rheumatoid arthritis?

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.

Besides joint pain, what other symptoms are associated with rheumatoid arthritis?

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.

Which joints are the most commonly affected by rheumatoid arthritis?

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.

What causes rheumatoid arthritis?

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.

Can rheumatoid arthritis be detected with blood work?

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.

Can you see the changes of rheumatoid arthritis in a regular Xray?

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.

Is there a cure for rheumatoid arthritis?

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.

Can my primary physician or internist treat rheumatoid arthritis?

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.

What is osteoporosis?

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.

What is lupus?

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.

What is scleroderma?

Scleroderma is a chronic autoimmune disorder that affects adults between the ages of 30 to 50, and typically affects more women than men. With scleroderma, the body produces too much collagen, which causes thickening of the skin and scarring of the internal organs. Symptoms can include thickening and hardening of the skin, red spots on the face and chest, swelling and pain in the fingers and toes, muscle weakness and diarrhea. Scleroderma can be controlled with anti-inflammatory drugs and steroids, blood pressure medication, exercise and stress management.