Rheumatoid Arthritis is a chronic, systemic inflammatory disorder that primarily affects the joints. Without treatment, it may result in deformity of many areas of the body. The joints may become swollen, tender, and warm with stiffness and a reduced range of motion. It can also be associated with extra-articular manifestations including fatigue, skin nodules, ulcerations, fibrosis of the lungs, inflammation of the eyes, anemia, osteoporosis, and atherosclerosis. Multiple medical therapies are available. Disease modifying antirheumatic drugs, such as methotrexate, are commonly used initially. Frequently, patients will advance to biologic medications, which are administered by injections or with intravenous infusions given in our office.
Lupus Erythematosus is an inflammatory disease, which can be systemic or purely cutaneous. Systemic lupus erythematosus is the most common and serious form. The symptoms vary from person to person, and typically include skin rashes, sensitivity to sunlight, hair loss, oral ulcerations, fatigue, anemia, and joint swelling. In serious cases, multiple organs can be involved, such as kidney or liver damage, fluid around the heart or lungs, seizure disorders, bowel inflammation, and thyroid dysfunction. Treatment typically begins with plaquenil or steroids, such as prednisone. Some patients require biologic therapy with benlysta.
Psoriatic Arthritis is an inflammatory joint disease related to the skin disease psoriasis. In most patients, the skin symptoms pre-date joint pain by several years. However, in some cases, the arthritis can present prior to skin manifestations. This disease can result in multiple swollen and tender joints with deformity. Treatment begins with disease modifying antirheumatic drugs, such as methotrexate. Frequently, patients must advance to biologic medications, which are administered by injections or with intravenous infusions given in our office.
Gout is an inflammatory disease characterized by recurrent flares of joint swelling and pain. The great toe is the most common area of the body affected, but any joint can be involved. Gout results from an increase in uric acid, which causes sharp crystals to form in the joints and skin. In addition to joint damage, patients may experience the formation of nodules known as tophi. Dietary modification may be required, including avoiding the excessive intake of alcohol, red meat, high fructose corn syrup, and shellfish. Treatment typically includes allopurinol, uloric, anti-inflammatories, or steroids.
Osteoarthritis is a mechanical abnormality involving degradation of joints. Patients experience a loss of articular cartilage, which results in pain and a decreased range of motion. Typical symptoms are joint pain that is worse with activity, tenderness, locking, and clicking. Treatment generally involves a combination of physical therapy, pain medication, orthotic devices, injections, and even surgery in severe cases.
Fibromyalgia is a syndrome characterized by widespread pain, thought to be related to abnormalities in how signals are processed in the central nervous system. However, the cause of fibromyalgia remains unknown. Medical treatment is helpful, but patients must perform aerobic exercise and obtain adequate rest. Medications typically include cymbalta, lyrica, savella, and/or muscle relaxants.
Vasculitis is a group of disorders that can cause blood vessel damage due to inflammation. Symptoms can manifest as rashes, nervous system damage, renal failure, or lung disease. Diseases include granulomatosis with polyangiits (GPA/Wegener’s), Behcet’s disease, leukocytoclastic vasculitis, Churg-Strauss syndrome, Kawasaki disease, and others. Treatment frequently requires steroids and immunosuppressive therapy.
Myositis is a group of disorders that involve muscular inflammation. Patients experience muscle weakness and may have rashes as well. Blood tests and muscle biopsies may confirm the diagnosis. Common disorders include dermatomyositis, polymyositis, and inclusion body myositis. Treatment frequently involves steroid therapy and immunosuppressive medication, along with physical therapy.
Sjogren’s Syndrome is an autoimmune disease that is characterized by the destruction of the body’s exocrine glands, specifically the salivary and lacrimal glands. Patients experience oral and ocular dryness, and may have joint pain as well. Sjogren’s syndrome can be secondary to another autoimmune condition, but can also occur by itself. Treatment is usually symptomatic, such as eye drops, oral lozenges, and vaginal lubricants. In some cases, chronic medication may be required.
Ankylosing Spondylitis is an inflammatory arthritis that primarily affects the spine. This can involve other joints as well, but typically begins at the sacroiliac joints, which connect the spine to the hips. Without therapy, the spine can slowly fuse, which causes a significant reduction in a patient’s range of motion. Treatment may involve oral therapy, but frequently requires biologic medications, which are given as injections or as intravenous infusions in our office.
Osteoporosis is a progressive bone disease characterized by a decreased bone mass, which may lead to fractures. This can be age-related, by may also be related to medications, such as prednisone, thyroid disease, malnutrition, weight loss surgery, and smoking tobacco. Dual energy x-ray absorptiometry (a DEXA scan) is used to evaluate the bone mineral density of a patient. Treatment includes calcium and vitamin d supplementation, weight bearing exercise, and medication, such as prolia, reclast, fosamax, boniva, or actonel.
Systemic Sclerosis (Scleroderma) is an autoimmune disease characterized by thickening of the skin. Other organs may be involved as well, including the lungs, kidneys, and gastrointestinal tract. Diagnosis is by clinical suspicion and the presence of autoantibodies on laboratory analysis. Treatment largely depends on the organ system involved. Topical therapy or blood pressure medications may be used for digital ulcerations. Esophageal dilatation might be performed by a gastroenterologist for difficulty swallowing. Medication may be necessary for pulmonary hypertension or renal disease.
Juvenile Idiopathic Arthritis (Juvenile Rheumatoid Arthritis) is the most common form of arthritis in children and adolescents. It is an inflammatory autoimmune disease that can cause joint instability and growth abnormalities if left untreated. In some cases, the course of the disease is mild and only involves one or two joints. However, there are many patients that have several joints involved and require systemic immunosuppressive therapy.