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The most common conditions we treat are:
The most common conditions we treat are:
The disorder we treat most frequently is rheumatoid arthritis. The exact cause of rheumatoid arthritis is unknown. It affects an estimated 1.3 million people in the United States and is two and a half times more common in women than in men.
In most people affected, the onset of rheumatoid arthritis starts between ages 30 and 60. However, anyone can develop rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune disease that is chronic (ongoing). It causes inflammation of the joints on both sides of the body. The most common symptoms are pain, stiffness, and swelling in multiple joints. Affected areas typically include the hands, wrists, hips, knees, ankles, and feet, but the shoulders, elbows, and cervical spine (neck) can be involved as well. If the inflammation of rheumatoid arthritis is not controlled, it can damage the joint cartilage, which serves as the body’s shock absorber. Over time, if left untreated, this condition can deform the joints, causing erosions and fused joints in some cases.
There are many effective treatment options available for rheumatoid arthritis, especially if diagnosed early. These include various medications to control inflammation and reduce joint damage.
Osteoarthritis is the most common form of arthritis. It affects joints as they age, but can also affect younger individuals, especially if they have had previous injuries.
In patients with osteoarthritis, cartilage in the joint wears down over time, and eventually the joint becomes bone-on-bone with no cartilage protecting the bones.
Inflammation also occurs with osteoarthritis, not as much as with rheumatoid arthritis, but the joint can become warm and swollen. Sometimes injections with cortisone into the affected joint can help. Surgery is a possible option when osteoarthritis is severe. Otherwise, anti-inflammatory medicines can be helpful. Many people live with osteoarthritis without any medication, but it is an extremely common disorder and treatment should be individualized.
Lupus (systemic lupus erythematosus) is a chronic condition that causes pain and inflammation in the body. It is an autoimmune disorder, meaning the body’s immune system mistakenly attacks tissues and organs.
The disease affects major organs including the kidneys, heart, and lungs as well as joints, blood cells, and the skin.
Some symptoms emerge immediately, while others develop over time. Symptoms vary from mild to severe and may only be temporary, although others can be permanent. Most lupus patients experience flare-ups.
Symptoms include a butterfly-shaped (malar) rash on the face that covers the cheeks and bridge of the nose.
Lupus mainly affects women. It is treatable and inflammation in the body can be limited causing the disorder to go into remission. Treatment of patients, based on the severity of individual cases, helps prevent permanent organ damage, especially in the kidneys. Lupus treatment has significantly improved over time, allowing patients with the disease to live normal lives.
Psoriatic arthritis is a chronic form of arthritis that affects the joints and the skin. It occurs in people who suffer from psoriasis, a condition that produces raised, red patches of skin, with thick silver-colored scaly plaques on parts of a patient’s body, including their knees, elbows, and scalp.
Joint stiffness, pain, and swelling are the main symptoms of the disorder and can affect both sides of the body, but often in an asymmetrical fashion like the right knee, left ankle, and only some of the finger joints, etc. The swelling or stiffness varies by patient and can be very mild or become quite severe.
Symptoms of psoriatic arthritis can resemble those of rheumatoid arthritis and joints can become painful and swollen. Symptoms can also spread to the nails which can become thickened or pitted.
There are several treatment options for the condition to reduce inflammation and prevent permanent joint damage.
Ankylosing Spondylitis is an inflammatory arthritis that affects the joints in the spine. Due to the inflammatory nature of this disease, the bones (or vertebrae) in the back become stiff and can fuse together, causing pain and reduced flexibility in the spine. Inflammation can occur in other parts of the body including the eyes.
Most people affected will develop the condition as young adults and, in most cases, will be diagnosed before age 45. An x-ray or MRI of the sacroiliac joints can identify ankylosing spondylitis. People who have the HLA-B27 gene or suffer from inflammatory bowel disease or psoriasis may be more at risk of developing ankylosing spondylitis.
With proper treatment, patients can look forward to living a normal life.
Gout is a common form of inflammatory arthritis characterized by sudden, severe attacks of painful, swollen, and tender joints. It is caused by buildup of uric acid in the blood which forms small needle-shaped crystals that can deposit in joints and cause inflammation.
The most common joint affected is the big toe, but gout can attack other joints in the feet, hands, wrists, ankles, knees, and elbows. Medications such as steroids, NSAIDs, and colchicine can be used to treat gout attacks while other medications like allopurinol can help lower uric acid levels and prevent gout attacks. Gout treatment aims for a uric acid level of 6 mg/ dL or lower to dissolve or prevent crystals. It is also helpful to avoid food and drinks high in purines that can trigger gout attacks such as red meat, shellfish, and beer.
Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Signs and symptoms usually begin quickly and are worse in the morning.
Most people who develop PMR are older than 65 and it rarely affects people under 50. Blood tests that detect inflammation such as the erythrocyte sedimentation rate (ESR or sed rate) and C-reactive protein (CRP) are often abnormally high. However, in some patients these tests can be normal or only slightly elevated. PMR is treated with low doses of corticosteroids such as prednisone, which typically provides relief within days. Prednisone is slowly tapered as symptoms improve but is sometimes needed for 1-2 years or more. Symptoms often recur, especially if the medicine is decreased too quickly. Other medicines like methotrexate or tocilizumab can be tried if patients are unable to taper off steroids.
Sjogren’s Syndrome is a systemic autoimmune disease that affects the entire body. The most common symptoms are dry eyes and dry mouth, but fatigue and musculoskeletal pain are common as well.
Other potential complications include other areas of dryness, internal organ involvement, neurological complications, and lymphomas. Sjogren’s affects 3-4 million Americans and is much more common in women. People of all ages and races are affected, but most are diagnosed between the ages of 40-60. It can occur by itself or in conjunction with other autoimmune conditions such as rheumatoid arthritis or lupus. Sjogren’s can be diagnosed by a combination of symptoms, tests that measure tear or saliva production, lab tests, or a biopsy. Treatment is aimed at relieving the symptoms such as dryness, joint pain, etc.
Fibromyalgia is a chronic disease in which patients feel pain and muscle tenderness throughout the body. Research has shown that this disorder affects the way the brain and spinal cord process painful and non-painful signals.
Patients usually have difficulty sleeping and often feel tired and fatigued. Most who suffer from the disorder experience bouts of pain sensitivity.
Pain can be felt anywhere in the body with fibromyalgia, but the discomfort will likely be felt most in the head, neck, arms, shoulders, chest, abdomen, back, and buttocks. Pain levels vary from patient to patient, but most experience a burning sensation, throbbing, or general achiness. In many cases, patients may also feel numbness or tingling and have painful areas that are sensitive to the touch. Patients also experience mood swings and memory loss.
Fibromyalgia can affect anyone, but more women suffer from the disorder than men. An estimated 11 to 15 million people in the US suffer from this chronic condition. Most patients develop the condition in middle age. In some cases, however, the disease can begin as early as childhood. The chances of developing the condition increase with age and can be even more common in patients who suffer from other diseases such as rheumatoid arthritis, lupus, chronic back pain, depression, or anxiety.
Fibromyalgia can be treated and managed through medication designed to limit the symptoms and help to reduce pain.
Vasculitis is an inflammation or narrowing of blood vessels, which reduces blood flow and causes damage to the body’s tissues and organs. There are several different types of vasculitis which can affect people of all ages.
Most types of vasculitis are rare and can vary from mild to severe. These blood vessel changes can affect large, medium and small vessels throughout the body causing damage to the kidneys, lungs, nerves, skin, heart, and other organs.
The condition is treatable depending on the severity of each case. Medications are prescribed to prevent flare ups and to help control the inflammation of the blood vessels and prevent damage.
Scleroderma, also known as systemic sclerosis, is a chronic autoimmune connective tissue disease in which inflammation in the skin and other parts of the body causes the formation of patches of tight, hardened skin.
Scleroderma is rare and women are more often affected.
Scleroderma can be categorized as “limited” or “diffuse”, depending on the degree of skin involvement. The tightening and hardening of the skin is like a scarring of the skin. Internal organs including the kidneys, lungs, heart, and digestive system can be affected. A white or blue discoloration of the fingertips in response to cold temperatures or stress called Raynaud’s disease is common in patients with scleroderma.
Myositis is a chronic autoimmune inflammatory disease that causes muscle weakness. Inflammation results when the immune system mistakenly attacks the body’s tissues and muscle groups.
Polymyositis mainly affects the muscles while dermatomyositis affects the skin as well as the muscles.
Myositis can be treated with medication to reduce inflammation and limit the severity of symptoms including muscle weakness. Patients may also be prescribed stretching or exercise to limit weakness in affected muscles and joints.
