May is Arthritis Awareness Month and SIMEDHealth Rheumatologist, Dr. Rodriguez, discusses the different types of arthritis, arthritis causes, symptoms, and treatment options.

In the U.S. 58.5 million people have arthritis. According to the CDC, "Arthritis is a leading cause of work disability, with annual medical care and lost earnings costs of $303.5 billion." Joints are where the bones meet, and arthritis is inflammation or destruction of a joint. SIMEDHealth Rheumatologist, Dr. Miguel Rodriguez, discusses the common symptoms of arthritis including pain, swelling, stiffness, redness, and decreased range of motion. If you have these symptoms or you or someone you love is suffering from arthritis, talk to your doctor to receive proper treatment. To schedule an appointment with our Rheumatology clinic, click here.

If you're unable to see the video, watch here https://youtu.be/WkbAqJOJJTg

https://www.cdc.gov/chronicdisease/resources/publications/factsheets/arthritis.htm

We had questions about osteoporosis and SIMEDHealth Rheumatologist Dr. Miguel Rodriguez had answers!

Dr. Rodriguez sees patients at our Gainesville and Ocala locations; to schedule an appointment, visit https://bit.ly/3t2VJhd .

1. What is osteoporosis?

Osteoporosis is a common bone disease that leads to an increased risk of fracture. Throughout our lives, our bones are constantly being broken down and built up again. Osteoporosis occurs when too much bone is lost and/or too little is made. This causes bones to become brittle and easier to break. In more severe osteoporosis, a minor trip, bump or even a sneeze may be all it takes to break a bone.

2. What are the symptoms of osteoporosis?

Most people with osteoporosis do not know they have the disease until they break a bone which is why osteoporosis is often called a “silent” disease. Once a bone fractures, it can be very painful and may take a very long time to heal. Some symptoms can become more noticeable with worsening disease and may include:

• A gradual loss in height because of compressed vertebrae
• Stooped posture or “Dowager’s hump”
• Persistent back pain from collapsed or fractured vertebrae or other bone pain
• More frequent fractures

3. What are the risk factors for osteoporosis?

Your risk of osteoporosis depends on:

• Your age – bone density declines at a faster rate after the age of 50
• Your diet – a regular intake of calcium and other minerals helps maintain bone health
• How much you exercise and what type of exercise you do - weight-bearing exercises increase bone density
• Sex hormone levels – women after menopause and men with low testosterone are at higher risk
• Sun exposure – sun is needed in small amounts for our skin to make vitamin D
• What other medical conditions you have – people with celiac disease, Crohn’s disease, or rheumatoid arthritis have a higher risk of osteoporosis
• What medicines you take – corticosteroids, antiandrogens, and aromatase inhibitors increase risk
• If you are deficient in any vitamins and minerals such as vitamin D or calcium
• How much you smoke or drink – smoking or a high alcohol intake increases risk
• How much you weigh – people who are underweight generally have lower bone densities
• If you have had any previous fractures

4. How is osteoporosis diagnosed? 

Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:

• Women over age 65
• Women of any age who have factors that increase the chance of developing osteoporosis

Your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone. The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, painless, and noninvasive test. DXA uses low levels of x-rays as it passes a scanner over your body while you lie on a cushioned table. The test measures the BMD of your skeleton and at various sites that are prone to fracture, such as the hip and spine. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk.

A person can also be diagnosed with osteoporosis if they have a fragility fracture. Fragility fractures occur as a result of “low energy trauma”, often from a fall from standing height or less.

5. What medications are available to treat osteoporosis?

There are a number of different medicines used to treat osteoporosis. Some work by decreasing how fast bone is broken down, others increase the rate at which bone is built back up. Some can only be used in postmenopausal women.

Common medicines prescribed for osteoporosis include:

• Bisphosphonates such as Actonel, Atelvia, Boniva, Binosto, Fosamax, Reclast, and Zometa
• Hormone therapies, that replace missing hormones or mimic the actions of hormones, such as Calcitonin, Duavee, Evista, Femhrt, Forteo, Premarin, or Tymlos
• Prolia – directly targets cells breaking down bone

6. Can osteoporosis be reversed?

Yes! Several treatments have been shown to improve bone density which slows or reverses the progression of osteoporosis, reducing the risk of fracture. However, osteoporosis cannot be cured indefinitely.  It requires ongoing actions to maintain your bone density. It’s never too late to treat your osteoporosis.  Don’t wait for a fracture to take action.

One of the last of our new doctors to start this month is rheumatologist, Dr. Danielle Desa. She is a University of Florida alumni completing both a residency and fellowship at UF Health as well. We chatted with her a little about her choosing rheumatology as her specialty and her interaction with patients. 

1. When did you know you wanted to be a doctor?

Dr. Desa explains she wanted to become a doctor since she was a child. “I was treated for scoliosis as an adolescent, and much appreciated the impact that medicine and caring practitioners had on my own life. I find it my calling to provide high-quality medical care for others,” she says.

2. Why did you choose to become a rheumatologist?  

“It is an exciting time to be a Rheumatologist,” states Dr. Desa. Rheumatology is a continually expanding field with cutting edge medications being made available consistently. She says she enjoys getting to treat patients of all ages from diverse backgrounds. “I can provide many effective treatment options, and I find it rewarding to deliver care that dramatically improves people’s quality of life and functionality.”

3. What conditions are you able to diagnose and treat?   

“I specialize in autoimmune forms of arthritis, but also treat a wide variety of other disorders that affect many organ systems. A few of the diseases I commonly treat are Gout, Rheumatoid Arthritis, Osteoarthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Sjogren’s Syndrome, Systemic Lupus Erythematosus, Scleroderma, Vasculitis, Polymyalgia Rheumatica, and Dermatomyositis.”

4. How would you describe your bedside manner?    

“I aim to provide a comprehensive approach to each person I treat.  I spend time listening to my patient’s concerns, and I am compassionate to their needs. I always work as a team with my patients to identify the goals that are important to both of us and come up with an individualized treatment plan.” 

5. What do you enjoy doing outside of work?   

Dr. Desa loves to travel, exercise, have fun with her two dogs, and spend quality time with her family and friends!

This board-certified physician started seeing patients yesterday September 3rd, sees patients in both Gainesville and Chiefland. Click here to schedule an appointment with her today!

Dr. Sheetal Patel is our newest rheumatologists at SIMEDHealth and we picked her brain about what psoriasis is, what its triggers are, and how she goes about treating her patients. If this video is not shown below, click here.

Over 5 million people around the world are affected by this disease with 16,000 new cases each year. May is Lupus Awareness Month, and we talked to rheumatologist Dr. Mark Lloyd about the different aspect of this autoimmune disorder. 

1) Lupus and its symptoms.

Dr. Lloyd says it is, "An autoimmune disorder where your immune system is making antibodies against its tissues." This often results in inflammation, which can affect major body systems from the brain to blood cells.  Symptoms can be multiple and hard to pin down as they often overlap with other ailments and are different for everyone, but a facial rash (otherwise referred to as butterfly wings) is the most common. Other symptoms include arthritis, fever, hair loss, joint pain, skin lesions, to name a few. 

2) Getting this disorder.

There is no known cause, but Dr. Lloyd says, "It is a genetic disorder, and doctors think something environmentally can trigger it." So it is more than likely someone has a "tendency towards lupus" and then they are triggered by something like an infection, a medication, or even sunlight. 

3) Life expectancy with lupus. 

This is an autoimmune disease that can end a person's life. One of the leading causes of death for people with lupus is kidney failure as the disorder causes kidney damage. Dr. Lloyd says, "Life expectancy is shorter, but with today's treatments, it has a much better prognosis." Overall, if a person with lupus can keep themselves as healthy as they can, they can live a normal and long life. 

4) A treatment plan.

Dr. Lloyd says, "Different medications such as steroids, immuno-suppressants, monitored closely with office visits, lab work, a good relationship with your rheumatologist goes a long way in excellent medical care for this disease." As more is discovered about lupus, treatments only get better. 

Lastly, Dr. Lloyd wants it to be known that lupus has been an over diagnosed disease, which can be frustrating for the patient as they would have to go through unnecessary and distressing treatment. But if a patient does receive an accurate lupus diagnosis, there is much better care in this day and age than ever previously. 

Dr. Lloyd is a rheumatologist located in Gainesville. Click the link to find out more about SIMEDHealth Rheumatology and Dr. Lloyd. 

According to the American Autoimmune Related Diseases Association, 50 million Americans currently are living with an autoimmune disease. We recently sat down with Rheumatologist Dr. Maurice Rodriguez to discuss the effects of food on the body for people with autoimmune diseases.

Dr. Rodriguez says, “An autoimmune disease is a condition where the body reacts against itself.” Normally our immune system fights against foreign substances, like bacteria, but people with an autoimmune disease have an immune systems malfunction and it ends up attacking its own tissue. This can have very long term and destructive effects on their bodies. There are more than 80 types of autoimmune diseases with the most common being Rheumatoid arthritis, Lupus, and Celiac Disease but are different symptoms for each autoimmune disease, though a common symptom for all of them is inflammation and joint swelling.

What we eat can play a role in how autoimmune diseases behave but it is not clear how and why. A large part of the immune system is in the gut so it is safe to say there is a connection. That being said, eating healthy can help overall but eating unhealthy can add fuel to the fire. Rodriguez says “Eating well will not solve the problem but help the patient feel better overall which can make a real difference in the quality of life.”

 Examples of Foods that can help the most:

• Fatty Fish (omega 3)
• Leafy Greens
• The whole spectrum of food can help get the most vitamins and nutrients

Examples of Foods that hurt the most:

• Sugar
• Processed food
• Anything that comes in a box
• Ingredients you can’t pronounce
• If your grandma wouldn’t recognize it

Dr. Rodriguez’s advice to people living with an autoimmune disease: find out as much as you can about your disease and take ownership of it. Eating right and exercising will help everything work better. Small steps towards eating better consistently over time will help and be easier on you. Also, “don’t do anything strange.”

Rheumatologist Dr. Rodriguez also treats and diagnoses osteoarthritis, joint pain problems, chronic pain, and non-operative orthopedics. If you are experiencing inflammation and other autoimmune disease symptoms or are already diagnosed with an autoimmune disease but you want to learn more about eating well, click here to schedule an appointment with Dr. Rodriguez.

Dr. Tina Brar of SIMEDHealth's Arthritis Center recently wrote an article for House Calls Magazine, a seasonal publication for the Alachua County Medical Society. The following article discusses advances in the treatment of psoriatic arthritis. 

View the full article below:

To request an appointment with Dr. Brar, click here

Article content:

Introduction
Although  psoriasis  has  been  described  since  the  time of   Hippocrates,   psoriatic   
arthritis   was   identified   as   a separate disease entity in the 1960s by what is now the 
American College of Rheumatology (ACR).  Initially thought to  be  benign,  it  is  now  recognized 
 as  a  member  of  the spondyloarthropathies  and  is  a  debilitating,  progressive illness with 
a comparable impact on functional ability and quality of life as rheumatoid arthritis (RA).  Early 
diagnosis is  imperative  to  prevent  long-term  disability  and  ensure optimal management of the 
disease and its comorbidities.

Psoriatic   arthritis   (PsA)   is   a   complex   affliction   with musculoskeletal involvement- 
including arthritis, dactylitis, enthesitis and/or axial involvement as well as skin and nail 
disease.   Although the exact pathogenesis is not known, it is thought that genetic, immunologic 
and environmental factors play a role.   The prevalence of PsA in the United States  is  around  
0.25%,  however  about  30%  of  patients with psoriasis also have psoriatic arthritis, affecting 
men and women equally.   It is therefore prudent to screen all psoriasis patients for PsA.  Varying 
patterns of the disease mimic different inflammatory conditions, such as gout and RA.  
Approximately 15% of patients develop arthritis prior to skin involvement, making the diagnosis 
difficult.  Generally, laboratory tests are unhelpful as there is no specific test for PsA and 
systemic inflammatory markers may be elevated in only half the cases.  The genetic marker HLA-B27 
is not a diagnostic test as no more than 2% of people born with this  gene  will  eventually  
develop  a  spondyloarthropathy. A    multidisciplinary    approach    between    dermatology and  
rheumatology  is  helpful  in  analyzing  many  cases. Recognition of this disease process has 
increased with the introduction of the classification criteria, CASPAR, as well as the development 
of several screening tools that allow for timely intervention.

Treatment

Anecdotally,  treatment  options  for  PsA  were  limited  to non-steroidal    anti-inflammatory    
drugs    (NSAIDs)    and conventional    disease-modifying    anti-rheumatic    drugs (DMARDs).  
Initially developed to treat rheumatoid arthritis, these   medications   have   varying   benefits  
 in   treating inflammation and the vast manifestations of PsA as well. Multiple systematic reviews 
have determined that the effect size of these DMARDs such as methotrexate, sulfasalazine and 
leflunomide are not very high and cyclosporine is seen as  toxic.   Corticosteroids  can  be  used  both 

locally  as injections and systemically, although not supported by evidence-along  with  the  concern

  of  rebound  psoriasis upon withdrawal of the drug.

Spanning  the  past  decade,  the  availability  of  targeted synthetic   and   biologic   DMARDs   
has   revolutionized treatment.    Given  these  advances,  a  “treat-to-target” approach  towards  
management  has  been  proposed, following  its  favorable  application  in  other  rheumatic 
conditions.     The  ultimate  objective  of  therapy  is  to procure the lowest possible level of 
disease activity in all aspects of the illness.  Despite a lack of cure, there are now effective 
treatments.

Tumor necrosis factor inhibitors (TNFi), which block the inflammatory  mediator  TNF-α,  have  been 
 around  for over  two  decades  and  have  established  breakthrough efficacy in patients with 
PsA. Five TNFi are now available, including adalimumab, etanercept, infliximab, golimumab and  
certolizumab.   Along  with  improvement  in  clinical signs  and  symptoms,  these  treatments  
also  decrease radiographic evolvement of disease.  All TNF-α blockers have been studied in 
randomized control trials as well as  in  observational  studies  with  consistent  evidence 
supporting  their  efficacy  and  safety  in  PsA.   Currently, trial  data  is  limited  in  
regards  to  switching  from  one inhibitor to another, although clinically it is a successful 
strategy.    The  choice  of  agent  is  based  upon  patient preference as well as regulatory and 
payor requirements and/or limitations

In  recent  years,  new  biologics  with  alternative  modes of  action  have  also  been  tested  
and  approved  in  PsA. Ustekinumab  is  an  FDA  approved  IL  12/23  inhibitor with  evidence  in 
 treating  arthritis,  skin,  enthesitis  and dactylitis. Guselkumab, an IL-23 blocker, is 
currently FDA approved for psoriasis only and is under investigation for the management of PsA with 
promising data.

Research  now  highlights  the  importance  of  the  TL- 17  pathway  and  a  number  of  therapies 
 targeting  this pathway  are  being  studied.    FDA  approved  anti-IL-17 therapies    include    
secukinumab    and    ixekizumab. Currently  brodalumab  is  FDA  approved  for  psoriasis only, 
but has shown efficacy in trials for PsA as well.
Tofacitinib  is  an  oral  inhibitor  of  Janus  kinase  that has  demonstrated  efficacy  in  the  treatment  of  PsA  in several  randomized  trials  including patients  with  both an  inadequate  response  to  conventional  DMARDs  and TNFα(alpha) to inhibitors.

Abatacept,   a   selective   T-cell   costimulation   modulator used  in  the  treatment  of  
rheumatoid  arthritis,  has  also shown  benefit  in  patients  with  PsA  in  limited  published 
randomized  trials  and  therefore  became  FDA-approved last year.

Apremilast,  a  phosphodiesterase  4  inhibitor,  is  a  newly targeted   synthetic   DMARD   that  
 induces   suppression of  several  inflammation  mediators  including  IL-2,  IL-12, TNF-α, IFN-γ 
and inducible nitric oxide synthase. Efficacy and  safety  in  PsA  has  been  demonstrated  
through  four multi-centric, randomized trials (PALACE Trials) compared to placebo in patients who 
failed other biological options.

Unfortunately,   evidence-based   guidelines   to   navigate
how these therapies should be used are lacking.   Several 
international   and   national   recommendation   sets   are created such as GRAPPA (figure 1) and 
EULAR, with the aim to help rheumatologists in everyday clinical practice management.     At  this  
time,  drug  choices  are  made according  to  available  safety  data,  presence  of  extra- 
articular  manifestations,  cost  and  patient’s  preference. Information  directly  comparing  all 
 biological  drugs  and assessing the efficacy of treatment options specific for PsA  is urgently 
needed.

Conclusion
The  hope  is  that  in  the  future  PsA  patients  will  be treated earlier and more aggressively 
with targeted drug therapies to escape marked progression of joint damage. Moreover, with effective 
management of the skin and joint disease as well as the  consideration  of  risk  factors for 
comorbidities, it will be reasonable to expect to improve the quality of life and function in these 
patients.

References available upon request.

Run a Half Marathon: New Year’s Resolution

Thank you to everyone who submitted their New Year’s resolution for the Health Goals 2018 project. New Year’s Resolution #1 was submitted by Kelly of Gainesville. Kelly wants to “recover from an ankle injury and complete a half marathon.” 

Dr. Miguel Rodriguez, a SIMED rheumatologist in the Gainesville Arthritis Center, has run numerous marathons. He weighed in on the situation and provided a few tips.

1. Get a good pair of running shoes for your specific foot type. The following shoe stores can evaluate how you run and recommend the right shoes for you:
- The Gainesville Running and Walking Store - http://runningandwalkingstore.com/
- Lloyd Clarke Sports - https://www.lloydclarkesports.com/
- Fit2Run - https://www.fit2run.com/

2. Make sure to warm up and cool down and stretch your feet and ankles.
- Dr. Rodriguez recommends and uses the YOFIT foot stretcher. - http://a.co/i4cKCKN
- If you don’t want to purchase a foot stretcher, you can still stretch your ankle and feet using your surroundings as a tool. For instructions and a video walk-through, visit the New York Road Runners website: http://www.nyrr.org/youth-and-schools/running-start/coaching-videos/high-school/stretches-strength/ankle-stretches

3. Follow a half-marathon training plan.
- There are apps and many available resources online that will prepare you for a half marathon. Dr. Rodriguez suggests using Jeff Galloway’s half marathon training plan: http://www.jeffgalloway.com/training/half-marathon-training/

4. Avoid overeating.
- Running and being more physically active is not an excuse to eat poorly. Stick to a paleo or Whole 30 approach for your food.
- The Whole 30 diet focusses on healthy, unprocessed food. People who follow the diet avoid consuming grains, alcohol, added sugar, dairy and other unhealthy foods. You would wait until 30 days after starting the diet to weigh yourself for the first time. Learn more: https://whole30.com
- The paleo diet also avoids processed food, dairy, grains and alcohol and focusses on eating food as our ancestors did many years ago. Learn about the paleo diet: https://robbwolf.com/what-is-the-paleo-diet/
- You can also use the slow cooker to make sure you always have food ready. When you increase your activity, you will get hungry. The internet has an abundance of free recipes for whatever you want to eat. One of Dr. Rodriguez’s favorite recipes is Slow Cooker Kalua Pig: http://nomnompaleo.com/post/10031990774/slow-cooker-kalua-pig

5. If you are looking for support, resources are available in the area.
- The Florida Track Club hosts group runs: https://floridatrackclub.wildapricot.org/
- Local running stores also host events: https://www.fit2run.com/store-event-calendar/

With these tips in mind, you will be well on your way to running a half marathon. Remember to take your time and move at your own pace. If you experience any pain, take a break and consult a doctor if necessary. 

To schedule an appointment with Dr. Rodriguez in Gainesville, call (352) 378-5173 or request an appointment online. For an appointment with another rheumatologist, call:
Gainesville: (352) 378-5173
Ocala: (352) 291-0245
Chiefland: (352) 378-5173
Lady Lake (The Villages): (352) 391-6450
Or request an appointment online.

Tai Chi is a meditative martial art that features slow, gentle movements and deep breathing. It is a series of exercises that flow from one to the other with an emphasis in proper posture. It is meditation in motion.

By SIMED Rheumatologist Dr. Miguel Rodriguez

Low Risk

I recommend tai chi to my patients because it is a low impact exercise that may benefit people with arthritis. There is a low risk of injury for the patients, and most people can do tai chi. Medical evidence on tai chi is difficult to find because people have difficulty studying it in randomized controlled trials. There is also a lack of funding for the studies, but from the research that exists, tai chi has been found to be very beneficial for the aging population.

"A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age," says Peter M. Wayne, assistant professor of medicine at Harvard Medical School and director of the Tai Chi and Mind-Body Research Program at Harvard Medical School's Osher Research Center.

Tai Chi For Arthritis Part 1 (Shoulder): 

Highly Beneficial

For patients with arthritis, tai chi improves balance, muscular strength, mobility, flexibility, and psychological health. It also decreases pain and helps prevent falls.

I recommend patients do tai chi at least one hour per week, but they can start at their own pace and increase as tolerated. I think it’s better to start slow and keep doing it over the long term than to overdo it the first day or week and stop.

Tai Chi For Arthritis Part 2 (Neck): 

Starting Tai Chi

Elder Options offers tai chi classes in Gainesville for patients with arthritis and for improving one’s balance. I also recommend watching videos on YouTube and checking out the library, which is a great resource and sometimes has postings on the bulletin board for tai chi.

Who Should and Shouldn’t Do Tai Chi

Patients with arthritis, osteoporosis, recurrent falls, and fibromyalgia would benefit the most from tai chi.

If you have a limiting musculoskeletal problem or medical condition – or if you take medications that can make you dizzy or lightheaded – check with a doctor before starting tai chi. Tai Chi has an excellent safety record, so chances are that you’ll be encouraged to try it. If you feel uncomfortable doing anything, you should stop and talk with your doctor.

In addition to tai chi, patients should stay active, work on their weight and reduce their stress.

Tai Chi For Arthritis Part 3 (Spine):

If you would like to schedule an appointment with Dr. Rodriguez, please call the SIMED Arthritis Center in Gainesville at (352) 378-5173 or request an appointment online.

For an appointment with SIMED Rheumatology in any of our locations, call:
Gainesville: (352)378-5173
Ocala: (352) 291-0245
Chiefland: (352) 378-5173
Lady Lake (The Villages): (352) 391-6450

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Arthritis is a disease that impacts more than 50 million Americans, making it the number one cause of disability in the country. That means 1 in every 5 adults, 300,000 children and countless families are affected by arthritis. – Arthritis Foundation, 2016

Dr. Miguel Rodriguez of SIMED Arthritis Center breaks down some of the components of how arthritis works and why it’s such a debilitating disease.

How does someone develop arthritis?

“You can break up arthritis into two different types, there is osteoarthritis and inflammatory arthritis. Osteoarthritis is a result of wear and tear that ends up happening as a function of age or it could be a result of long term repercussions of having some type of trauma to the body. For example, if you break your ankle and as it heals you continue to walk on it, you can develop arthritis in your ankle. Then there is inflammatory arthritis which is generally classified as an auto immune disease so that means that someone’s own immune system is reacting against their own joints” says Dr. Rodriguez.

Are there certain predisposition to arthritis?

So again we are breaking it up into two different types of Arthritis. Obesity is a big modifiable risk factor for osteoarthritis. The wear and tear of weight bearing joints can be accelerated by obesity. As we get older, we will all eventually develop osteoarthritis.

Inflammatory arthritis can be passed down genetically from family members. Then there are certain things like Gout, which can be from being overweight or having bad kidney function.

Are there precautions someone can take to reduce their chance of arthritis?

It helps to maintain a healthy lifestyle. Staying active is important to keep your weight down. For every pound you lose, your taking four pounds off the knees.

What are some ways to cope with the symptoms of arthritis?

In general you want to try and stay active. Physical Therapy can be helpful to demonstrate safe exercise and stretches that can help decrease joint pain and improve conditioning. Topical creams can be beneficial for pain relief, and for some people, acupuncture helps.

What types of medications are there for arthritis and what do they do?

With Osteoarthritis you are trying to relieve pain so you start off with over the counter medicine like Tylenol(acetaminophen),which is your safest oral medication. Then you have anti-inflammatory medicines such as, Advil(Ibuprofen) and Aleve(Naproxen). Some of these anti-inflammatories are also available in prescription strength. Then you have opiates for extreme pain associated with osteoarthritis.

We consider rheumatoid arthritis a prototypical inflammatory arthritis. To treat patients, we generally start off with steroids in order to get the inflammation under control. Then we use different medications to keep the inflammation under control while we take away the steroids.

DMARD’s Biologic s are exciting newer medications we use to control the autoimmune reaction either individually or in combination to control their inflammatory arthritis. By getting control of the inflammatory symptoms, we are able to decrease or hopefully get people off their steroids.

What are the symptoms of Rheumatoid arthritis?

Joint swelling is the biggest symptom of rheumatoid arthritis. The joints will be visibly swollen, generally the hands will be most affected. This can really impact your day to day routine. For example, if you have to be at work at 8 o’clock, you may need to get up earlier to wait out the stiffness. The stiffness can last up to an hour after waking up. This is something you can help to differentiate between inflammatory arthritis and osteoarthritis.

What type of doctor should someone go to if they think they are developing arthritis?

You can see a Primary Care doctor if you think you are developing arthritis and they can refer you to see a specialist if need be. Your Primary Care doctor can send you to a rheumatologist, a specialist in arthritis. The Rheumatology works with other specialists if the arthritis results in complications requiring surgery or other interventional procedures.

Is there any research going on for arthritis relief?

There is a lot of research going on for rheumatoid and inflammatory arthritis. For these types of arthritis, they are generally caused by the immune system so there are different ways of working on modulating the system to stop the long term damage from the chronic inflammatory process.

Can arthritis be "cured"?

No unfortunately it cannot be cured. However, the idea is to be able to control the systems. So the rheumatoid arthritis will hopefully become in like diabetes or hypertension in some patients. Which means they will have to take medicine all the time but they won’t have any symptoms, or long term complications.

I understand some of the newer arthritis medications cant be taken by mouth. How are these medications administered?

An infusion room is where patients can receive medicines called biologics which are medicines used to control inflammatory arthritis. These medicines are given through an IV and block specific parts of the immune system that are responsible for the swelling or inflammation that cause rheumatoid arthritis. Many rheumatologist, including here at SIMED arthritis center, have infusion rooms incorporated in their clinics.

Can people develop both types of arthritis?

Yes, people can develop both inflammatory and osteoarthritis. People with inflammatory arthritis continue to age and their joints experience the typical wear and tear that leads to osteoarthritis.

As a Doctor how do you diagnose one over the other?

As a Rheumatologist the most important thing we do is have the patient give us a detailed health history and we do a physical exam. This helps differentiate if the problem is an ongoing issue between inflammatory arthritis and osteoarthritis. The doctor can tell the difference between the two by palpating the stiff joints as well as looking at the pattern of the joints involved.

Dr. Rodriguez encourages you to take control of your arthritis this year! If you’re not sure how to start you can begin by scheduling an appointment with a Primary Care physician or a Rheumatologist today! Click here to request an appointment online.