If you are asking the question, “what is rheumatology?”, you are not alone Why? because rheumatology is one of the least known branches of medicine. Rheumatology is a subspecialty of internal medicine devoted to the diagnosis and treatment of rheumatic diseases or musculoskeletal conditions. Rheumatic diseases affect the joints and connective tissues, cartilage and tendons. 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 it’s own tissues. Over 45 million people in the US are coping with some type of rheumatic disease. Here is a list of most common conditions treated by a rheumatologist. • Osteoarthritis • Gout • Rheumatoid Arthritis • Tendinitis • Lupus • Carpel tunnel syndrome • Polymyalgia Rheumatica (PMR) • Polymyositis A rheumatologist is an internist with specific training and experience in the diagnosis and treatment of musculoskeletal diseases and autoimmune conditions called rheumatic diseases. These diseases can cause pain, swelling, stiffness and deformity of joints, tendons, bones and muscles. Practicing rheumatologists have completed four years of medical or osteopathic education, three years of residency in internal medicine or pediatrics and a two year rheumatology fellowship. All practicing rheumatologists have also pass a test to become board certified.

Did you know that there are over 200 rheumatic diseases and conditions? Here is a list of the most common diseases and conditions to answer the question, “What conditions do rheumatologists treat?” Degenerative arthropathies - Osteoarthritis Inflammatory arthropathies -Rheumatoid arthritis -Spondyloarthropathies -Ankylosing spondylitis -Reactive arthritis (reactive arthropathy) -Psoriatic arthropathy -Enteropathic arthropathy -Crystal arthropathies -Gout -Pseudogout (Calcium pyrophosphate deposition disease (CPPD) -Septic arthritis Systemic conditions and connective tissue diseases -Lupus -Sjögren’s syndrome -Scleroderma (Systemic Sclerosis) -Polymyositis -Dermatomyositis -Polymyalgia rheumatica -Mixed connective tissue disease -Relapsing polychondritis -Adult-onset Still’s disease -Sarcoidosis -Vasculitis -Microscopic polyangiitis -Eosinophilic granulomatosis with polyangiitis (formerly known as Churg–Strauss Syndrome) -Granulomatosis with Polyangiitis (Formerly known as Wegener’s granulomatosis) -Polyarteritis nodosa -Henoch-Schönlein purpura -Giant cell arteritis, Temporal arteritis -Takayasu’s arteritis -Behçet’s syndrome -Buerger’s disease (thromboangiitis obliterans) Soft Tissue Rheumatism -Local diseases and lesions affecting the joints and structures around the joints including tendons, ligaments capsules, bursae, stress fractures, muscles, nerve entrapment, vascular lesions, and ganglia. Low back pain Tennis elbow Golfer’s elbow Olecranon bursitis

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. When should I go to a rheumatologist? -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. If you experience any of the reasons above, see a rheumatologist because: -Some rheumatic diseases, which can change and evolve, are very difficult to diagnose without specialized training. -Persistent “everyday type” symptoms can be related to more complex medical conditions. -Rheumatologists are specifically trained to evaluate all of your symptoms and diagnose complicated medical conditions. -Irreversible joint damage can occur if certain conditions are not diagnosed soon enough. -Many disorders or diseases respond best to treatment in the early stages.

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 the medical family history. -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. Expect to fill out forms. -Arrive 30 minutes early to fill out forms -Or print and complete these forms at home. Expect to show a valid picture ID, insurance card, pharmacy card and a method to pay your copay or deductible. -Be sure to have your primary care physician forward insurance referrals to the rheumatologist before your appointment date (if required) . When you are called back to the exam room, the nurse will take some vitals and ask you to change into a gown. When you see the rheumatologist expect the visit to be part friendly conversation and part physical exam. -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 bowls too. You will need to bend and flex your joints. All of the information will be captured on ipads and sent to our Patient Portal. The rheumatologist may order a blood test, x-rays, MRI, CT scan or ultrasound to assess often difficult to diagnose Rheumatic diseases. The Rheumatology Care Center doctor will not prescribe opioid / narcotics for pain management. We seek to find solutions to manage the underlying problem and not to manage pain. There are pain management experts who specialize in this type of care who can better serve you. After reviewing all of the history, tests and physical examination, the rheumatologist hopes to have most if not all of the pieces of the puzzle to provide an accurate diagnosis and develop a personal care plan that may include medications, physical therapy and/or joint injections. Please note that sometimes all of the puzzle pieces fall into place to create a complete picture, but with complex cases the rheumatologist will need to keep looking for any missing pieces of the puzzle.

One effective way to treat rheumatoid diseases and autoimmune disorders is infusion therapy. Rheumatology Care Center of Newtown Square provides on-site infusion therapies for the treatment of chronic conditions. 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 Rheumatology Care Center in Newtown Square, PA. What conditions can be treated with infusion therapy? -Rheumatoid Arthritis -Psoriatic Arthritis -Ankylosing Spondylitis -Lupus -Osteoporosis -Arthritis associated with Crohn’s Disease -Gout What can I expect during infusion therapy? Therapy is managed by Dr. Thais Moldovan and the experienced nurses here at Rheumatology Care Center. The staff is specially trained regarding all aspect of intravenous (IV) infusion including emergency procedures. You will sit 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. What medications are used in infusion therapy? -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. As with any medications there are possible serious side effects. Visit the websites or consult your physician about the pros and cons of the medications listed above.

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. When you do see a rheumatologist, it is very important to be precise and objective when describing your symptoms to your rheumatologist. Besides joint pain, what other symptoms are associated with rheumatoid arthritis? As a systemic disease, RA can affect multiple organs and systems in you 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 (PIPs and MCPs) 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 a 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. What other diseases can look like rheumatoid arthritis? -Gout -Pseudogout -Osteoarthritis -Polymyalgia rheumatica -Viral infections -Thryroid dysfunction -Lupus 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.

At the Rheumatology Care Center, we rarely, if ever, prescribe addictive opioids / narcotics. We seek solutions to the underlying cause of the pain, not solely pain management. If you are seeking pain management, there are experts who specialize in chronic pain management who can better serve you.