Rheumatology


Rheumatology


Rheumatology is the branch of medicine that encompasses musculoskeletal disease as well as systemic autoimmune conditions. The most common conditions treated by Dr. Gartshteyn include:


Rheumatoid Arthritis (RA)


Rheumatoid Arthritis (RA) occurs when the immune system causes the body to attack the joint’s lining. This is categorized as autoimmune and inflammatory disease, which means the immune system mistakenly attacks healthy cells in the body. RA affects the joints and can occur in multiple joints, such as in the hands, writs, and knees, at the same time. Inflammation of the joint lining causes pain and damage to the joint tissue. If left untreated, tissue damage can result in long-lasting or chronic pain, lack of balance, or deformity.

Signs and symptoms of RA can fluctuate between worse periods, or flares, and better periods, known as remission. There is a wide range of symptoms, which include any of the following:

  • Pain, tenderness, and/or swelling in multiple joints
  • Joint stiffness in the morning
  • Fatigue, or tiredness
  • Weight loss
  • Same symptoms on both sides of the body, such as in both hands, or both knees
  • Weakness
  • Lumps called rheumatoid nodules.

There are numerous genetic and environmental factors that may contribute to a person’s risk for developing RA. Although RA can manifest at any age, the likelihood increases with age and is highest among adults in their sixties. Genetics and inherited traits can also be a contributing factor. People who are born with the human leukocyte antigen (HLA) class II genotypes are more at risk to develop RA, especially when exposed to environmental factors such as smoking or becoming obese. Studies show that RA typically develops two-to-three times higher in women than in men.

It is important to diagnose RA early, within 6 months of the onset of symptoms, in order to begin treatment and slow or stop the progression of the disease. Rheumatologists are expertly trained to properly assess and treat  patients for RA, since the symptoms are often similar or overlapping with other inflammatory diseases.


Psoriatic Arthritis (PsA)

Psoriatic Arthritis (PsA) is a form of arthritis that simultaneously affects the joints and skin with inflammation. Specifically, the skin is affected by psoriasis, a chronic inflammatory skin condition that causes red patches and white flakes to appear on various areas of the skin. People affected by psoriasis may also have changes in their fingernails and toenails, which can become pitted, ridged, crumpled, or easily separated from the nail bed.

Symptoms of psoriatic arthritis include stiff, painful joints with redness, heat, and swelling in the surrounding tissues. When the hands and feet are affected, swelling and redness may result in a “sausage-like” appearance of the fingers or toes, otherwise known as dactylitis.

For most people with psoriatic arthritis, psoriasis appears before joint problems develop. Although both conditions may occur at any age, psoriasis typically begins during adolescence or young adulthood, and psoriatic arthritis usually occurs between the ages of 30 and 50. In a small number of cases, psoriatic arthritis develops in the absence of noticeable skin changes. Psoriatic arthritis can be difficult to distinguish from other forms of arthritis, especially when skin changes are minimal or absent.

Rheumatoid arthritis (RA) can have physical symptoms, but it can also have an impact on your mental well-being and lower your quality of life. Aside from causing physical discomfort and pain, complications from RA can lead to disability and premature death.

People suffering from RA are at a higher risk for developing other chronic diseases such as heart disease and diabetes. In order to prevent people with RA from developing premature heart disease, treatment of RA focuses on reducing heart disease risk factors such as cessation of smoking and opting to lose weight.

For patients with RA who are obese, they have an increased risk of developing heart disease risk factors such as high blood pressure and high cholesterol. Obesity in RA patients also increases the risk of developing chronic conditions such as heart disease and diabetes.

Trying to go about your daily life with RA can be difficult. As the disease gets worse, many people with RA find they are unable to do as much as they used to. For instance, work loss among people with RA is highest among people whose jobs are physically demanding. Work loss is lower among those in jobs with few physical demands, or in jobs where they have influence over the job pace and activities.

Treating RA and managing its symptoms is possible, as early detection is strongly encouraged. If you have any questions or would like to schedule an initial appointment with our rheumatologist, please contact CORE Medical & Wellness today!



Gout


Gout is an inflammatory arthritis that causes joint pain. The first episodes of arthritis usually start in the big toe joints, of which typical symptoms can include intense pain, swelling, redness, and heat. Gout flares can occur suddenly and last for days or weeks, followed by periods of remission when there are no symptoms. Over time, joints can become damage if left untreated.

Gout is caused by a condition called hyperuricemia, where the body has too much uric acid. The body naturally produces uric acid when it breaks down purines from food you consume. However, too much uric acid in the body can build up in joints, fluids, and tissues.

Although gout often occurs in the big toe, other joints that are commonly affected include lesser toe joints, ankle, and knee. In the early cases of gout, flare ups may begin at night and manifest suddenly. Gout attacks may be triggered by stress, alcohol, drugs, or another illness. Gout flares typically last for days or weeks and are followed by long periods of remission from weeks, months, or years.

The chances of developing gout may increase your chances if you:

  1. Are male
  2. Are an adult
  3. Are obese
  4. Drink alcohol
  5. Consume food and drinks high in fructose
  6. Have a diet with purine-rich foods, including red meat, organ meat, and certain seafoods such as anchovies, sardines, mussels, scallops, trout, and tuna
  7. Have certain health conditions such as congestive heart failure, high blood pressure, insulin resistance, metabolic syndrome, diabetes, and poor kidney function.

Rheumatologists are specialized physicians who are knowledgeable in treating inflammatory diseases. Since signs and symptoms of gout can appear to be similar to symptoms of other inflammatory diseases, patients should see a rheumatologist for appropriate diagnosis and treatment.

Treatment for gout ranges from medicine and self-management strategies. Patients can treat flare ups with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. In order to prevent future flares, patients can make diet and lifestyle changes such as losing weight, limiting alcohol, and eating less purine-rich food. For cases of uric acid build up, patients can take measures to prevent kidney stones and uric acid deposits under the skin called tophi. 

Millions of people are affected by gout at some point in their lives. After a prolonged period of time, gout may cause permanent damage to your joints and kidneys. There is no cure for gout, but with proper treatment, patients can manage pain symptoms and avoid long-term damage to joints.


Osteoarthritis


Osteoarthritis is the most common form of arthritis and it affects the tissue that covers the ends of bones in a joint. It mostly occurs in older people, though anyone can develop osteoarthritis at any age, especially from a joint injury. With osteoarthritis, or OA, the cartilage within joints begin to break down and slowly changes the bone. Pain can be caused as a result of bone spurs that grow on the edges of joints, or fragments of bone and cartilage that break off and float within the joint space.

Osteoarthritis affects over 30 million adults in the United States. It is a disease that damages cartilage, the slippery tissue that covers the ends of bones in a joint. Without this protection, the bones rub together and cause pain, swelling, and loss of motion of the joint. Osteoarthritis typically develops gradually over time and there are many factors to what may cause OA, such as the following:

  1. Obesity – extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees.
  2. Age – risk of developing OA increases with age
  3. Joint injury and/or stresses on the joints from physical activity
  4. Genetics – people who have family members with OA are more likely to develop OA, such as a genetic defect in joint cartilage

Although OA can occur in any joint, it most often occurs in the hands, knees, hips, and spine. Typical onset of symptoms include: joint stiffness after prolonged period of stillness; swelling or tenderness in one or more joints; and a crunching feeling or sound of joints rubbing.

A physician diagnoses OA through a review of symptoms, physical examination, X-rays, and lab tests. A rheumatologist is specially trained to diagnose inflammatory diseases such as arthritis and should be consulted for diagnosing osteoarthritis.

There is no cure for OA, but it can be treated with a combination of therapies and self-management strategies. Patients can increase physical activity, participate in physical therapy with muscle strengthening exercises, lose weight, use supportive devices such as crutches or canes, take over-the-counter pain relievers or prescription medication, and resort to surgery if all other treatment options have been exhausted.


Ankylosing Spondylitis (AS)


Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. It is also systemic and can affect other parts of the body such as the shoulders, ribs, hips, knees, and feet. In certain cases, AS can also affect the tendons and ligaments attach to bone; it can even affect the eyes, bowel, heart, and lungs. Symptoms involve redness, heat, swelling, stiffness, and pain in the spine or where pelvic bone joins at the bottom of the spine.

Like most arthritic conditions, it is unclear what is the exact cause of AS. However, it is more prevalent in men, as they are twice more likely than women to develop AS. Genetic and environmental factors may contribute to developing AS.

In order to diagnose AS properly, physicians will need to assess a patient’s medical history, conduct a physical exam, study images of the patient’s bones and joints, and also have blood work done. A rheumatologist usually gives the final diagnosis for ankylosing spondylitis, since this is a physician who is trained to treat arthritic conditions. However, since AS can affect different parts of your body, it is not unusual to see more than one doctor. Other physicians, such as an ophthalmologist (eye disease), gastroenterologist (bowel disease), physiatrist (physical medicine and rehabilitation), and physical therapist (stretching and exercise programs.

There is no cure for ankylosing spondylitis, but treatment is available to help manage symptoms and prevent the disease from progressing. There are safe and effective medicines to treat AS, such as:

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) which help relieve pain and swelling
  2. Corticosteroids also help relieve pain and swelling. This strong medicine is similar to the cortisone found in your body. 
  3. Disease-modifying antirheumatic drugs (DMARDs) work to reduce pain and swelling, and to slow down disease progression
  4. Biologic agents are newer types of genetically engineered proteins medicine that mimic normal biological functions

Exercise can help strengthen and stretch joints, but it is important to consult with a physician on what is the most beneficial exercise program for each patient. Often, patients with AS find that exercises in water are helpful to relieve joint pain. Furthermore, a healthy diet can help with weight loss, which in turn reduces stress on painful joints. Surgery should only be considered as a last resort. When AS causes significant joint damage and daily activities are too difficult, joint replacement is an option, with knee and hip replacements as the most common.


Systemic Lupus Erythematosus (SLE)


Systemic Lupus Erythematosus (SLE)  is an autoimmune disease that affects the entire body, including the joints, skin, kidneys, heart, lungs, brain, and blood vessels.  SLE is the most common type of lupus, but the causes of it are still unknown. 

Symptoms may come and go, and they can differ for each person, but the most common include: recurrent rashes, pain or swelling in joints, hair loss, sensitivity to the sun, recurrent low grade fevers, chest pain when taking a deep breath, pale or purple fingers or toes, mouth ulcers, swollen glands, and fatigue. Other symptoms may include lung problems, heart problems, kidney problems, seizures, psychosis, and blood cell and immunological abnormalities.

Although anyone can get lupus, women of childbearing age between 15 to 44 years are at an increased risk. Women of all ages are far more likely to be affected by SLE than men from an estimated ratio of 4 to 12 women for every 1 man. In addition, minority racial and ethnic groups (black/African American, Hispanic/Latinx, Asian, American Indian/Alaska Native) are affected more than white/Caucasian population.

SLE is relatively uncommon and difficult to diagnose. Although there is no cure, there are medical interventions and lifestyle changes can help control symptoms. Since it is an autoimmune disease that has overlapping symptoms with other autoimmune conditions, SLE treatment should involve a team of physicians. A rheumatologist specializes in assessing autoimmune diseases and utilizes specific criteria in diagnosing SLE.

In 2011, the FDA approved belimumab, an immunosuppressive drug that is used to treat SLE. Treating this disease mostly consists of immunosuppressive drugs that inhibit the activity of the immune system. Other medications include hydroxychloroquine and corticosteroids, such as prednisone, and they may help manage the disease by:

  1. Reducing swelling and pain
  2. Preventing or reducing flares
  3. Helping the immune system
  4. Reducing or preventing damage to joints
  5. Balancing the hormones
  6. Treating problems related to lupus, such as high cholesterol, high blood pressure, or infection

There are alternative methods that may help treat SLE symptoms, such as eating a proper diet, incorporating daily exercise, and utilizing relaxation techniques to help cope with stress. As always, promoting a healthy lifestyle that does not involve smoking will also reduce the risk of heart disease that can be a factor of lupus.


Idiopathic Inflammatory Myositis (IIM)


Idiopathic Inflammatory Myositis (IIM) is a group of autoimmune conditions involving inflammation of muscle fibers used for movement, or the skeletal muscles. IIM is typically reported in adults between the ages of 40 and 60 years, or in children between ages 5 and 15 years. Approximately 2 to 8 cases per million people occur each year for idiopathic inflammatory myopathy.

The specific cause of the disorder is unknown, but genetic and environmental factors may influence the development of IIM. One hypothesis is that specific genetic variations may increase a person’s risk of developing idiopathic inflammatory myopathy, which may be triggered by exposure to specific environmental factors such as medications, or ultraviolet light such as sunlight.

Most cases of IIM are sporadic, but it is noted that some people who suffer from IIM may have close relatives with other autoimmune diseases. Although a small percentage of IIM cases have been reported to be passed on in families, the condition does not have a clear pattern of inheritance.

The most prominent symptom of IIM is muscle weakness that develops gradually over a period of weeks, months, or years. This results in gradual, but progressive loss of strength and muscle tone. Other symptoms may include joint pain and general fatigue. The heart and the lungs can be involved, and an early diagnosis is important to minimize long-term damage.

Other common diseases that are categorized as IIM include polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM). Diagnosis is based on determining muscle weakness upon examination, elevated muscle enzymes, and muscle biopsy. It is important to be properly diagnosed and start therapeutic treatment as soon as possible.

The treatment goals for IIM are to manage symptoms by eliminating inflammation, restore muscle performance, reduce morbidity, and improve the patient’s quality of life. Because this is also categorized as a genetic condition, treatment and management strategies focus on improvement of symptoms associated with IIM.


Vasculitis


Vasculitis means inflammation of the blood vessels, which includes the veins, arteries, and capillaires. When a blood vessel becomes inflamed, it can narrow which makes it difficult for blood to get through. The blood vessel can also stretch and weaken so much to the point that is bulges; the bulge is called an aneurysm and it can cause dangerous internal bleeding if it bursts. As a result, it can also affect any organ in the body because it reduces blood flow to organs and tissues, including the brain, spinal cord, and peripheral nervous system.

The exact cause of vasculitis is often unknown, but it can occur when the body’s immune system attacks the blood vessel by mistake. It can also occur due to an infection, another disease, or triggered by an allergic reaction to medicine. Suggestive symptoms of vasculitis include ongoing fever, swelling, malaise, weight loss. In the older population, vasculitis can co-occur with polymyalgia rheumatica (PMR), an inflammatory condition that presents with shoulder and hip pain in the setting of elevated inflammatory markers detected on bloodwork.

Anyone can be affected by vasculitis, although some types can occur more frequently in people who have autoimmune disorders such as lupus and rheumatoid arthritis. It can be difficult to diagnose vasculitis since symptoms are similar to other diseases, such as vasoconstriction, a non-inflammatory disease that decreases the diameter of a blood vessel due to muscle contraction in the vessel. Onset of vasculitis symptoms may begin suddenly or develop over time and include:

  1. Prolonged headaches
  2. Fever
  3. Malaise, or general feeling out-of-sorts
  4. Rapid weight loss
  5. Confusion or forgetfulness that leads to dementia
  6. Aches and pains in the joints and muscles
  7. Pain while chewing or swallowing
  8. Paralysis or numbness typically in the arms or legs
  9. Visual disturbances, such as double vision, blurred vision, or blindness
  10. Seizures or convulsions
  11. Stroke or transient ischemic attack
  12. Unusual rashes of skin discoloration
  13. Kidney problems or other organs

The types of treatment and its duration is contingent upon each individual patient’s vasculitis symptoms. After patient assessment, it is common for long-term treatment goals to be needed in order to manage symptoms. There are effective medications used to treat vasculitis, such as glucocorticoid drugs, or steroids, like prednisone. Due to the anti-inflammatory effect and rapid response, this type of medication is often used as the primary treatment and are also prescribed with other immunosuppressive medications. Immunosuppressant, or cytotoxic, drugs help to decrease or stop the function of immune cells. Furthermore, a medication called Rituximan, which is a monoclonal antibody, targets immune cells that are functioning abnormally and destroys them. This helps to stop the inflammation and prevent flare-ups.


Symptoms


Most rheumatic diseases are categorized as autoimmune conditions, suggesting an aberrant immune system response in which the immune cells become reactive against one’s own body. The specific cause is unknown and the pathogenic mechanisms vary between the disease, however a combination of genetics and environment is likely responsible. Pain is the readout of inflammation and is the most common symptoms for which patients with autoimmune diseases seek help. Other symptoms include:

  • Swelling
  • Warmth
  • Stiffness
  • Fatigue
  • Muscle weakness
  • Fever and weight loss

Now at CORE Medical and Wellness, Dr. Gartshteyn brings her knowledge and experience as an expert rheumatologist to carefully assess each individual patient’s medical history and symptoms. With a focus on reducing pain and minimizing joint damage, Dr. Gartshteyn aims to improve or maintain physical function and quality of life for patients.



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