It might be time to seek a medical “detective” for your muscle and joint pain.
Most people know what a cardiologist or pediatrician does – can you say the same for a rheumatologist? Mention that medical specialty and chances are you will be met with at least a couple of confused looks. So what is a rheumatologist and when should you go see one?
“A rheumatologist is an internist who specializes in treating many different types of disorders of the body caused by an immune system gone awry, causing what is called autoimmune disease,” says Dr. Stephanie Kydd Dondero, a rheumatologist with White Plains Hospital Physician Associates. "An autoimmune disease occurs when the immune system gets confused. It believes it is fighting a virus or an infection with inflammation, but is actually attacking the body itself. "
Rheumatic diseases are very complex and can affect any organ. They can occur in eyes, skin, internal organs, muscles and joints depending on the type of disease, she explains.
Dr. Dondero answers some common questions to help you decide if it is time to schedule a visit.
What conditions does a rheumatologist treat?
Some autoimmune diseases you may have heard of are: rheumatoid arthritis, lupus, gout, sjogrens disease and psoriatic arthritis. Rheumatoid arthritis is when the body causes swelling and inflammation in the joints. Sjogrens disease can also result in joint pain, but tends to be associated with a dry eye and mouth. About 25 percent of the population suffers from arthritis, according to the American College of Rheumatology.
What will happen during my visit?
Your rheumatologist will take a detailed history and perform an exam of your joints, skin, musculoskeletal system and any other areas of the body that may be involved. We are looking for swelling and inflammation as well as any clues that can help us with the diagnosis. A rash, for example, can be quite helpful in the evaluation of many connective tissue diseases like lupus. After this, we may order appropriate lab work and radiologic testing. Once the diagnosis is established, the rheumatologist will review with the patient potential treatment plans. This can range from physical therapy to lifestyle modification, joint and tendon injections, medications or possible referral to another specialist. Rheumatologic diseases are difficult to diagnose and may take several visits to establish the diagnosis.
How do I know if I should see a rheumatologist over an orthopedic doctor?
Everyone experiences muscle and joint pain from time to time. Identifying the source of the pain is the first step in deciding what type of specialist to see for treatment. Orthopedic doctors typically deal with pain related to injury and chronic overuse of otherwise healthy joints. A rheumatologist tries to determine if the pain is related to an improperly functioning immune system, and if so, will prescribe the proper medication to stop this process from happening.
Some rheumatologic signs are: redness, warmth and swelling in your joints, prolonged stiffness in the morning lasting over one hour, and pain that is worse in the morning. Also, if you have a family member with an autoimmune disease, it increases the likelihood that your symptoms are related to an underlying autoimmune disease. For example, having a family member with psoriasis increases your risk of psoriasis arthritis (even if you have never had psoriasis yourself) I recommend asking your primary care doctor if he or she thinks your symptoms warrant seeing a rheumatologist.
Is arthritis one disease? Is it true only older people can get it?
No and no! Arthritis can describe over 100 medical conditions, and it can develop in all age brackets, from juvenile arthritis to inflammatory diseases, like rheumatoid arthritis, which starts in many patients in their 30s and 40s. Some other popular myths are: cracking your knuckles causes arthritis and exercise should be avoided. Both are false. Though there may be some impact on tendons, there is no evidence that knuckle-cracking leads to the development of arthritis. Patients with these conditions who exercise, especially when combined with physical and occupational therapy, help prevent disability and actually help to decrease pain, reduce disease symptoms and increase overall flexibility and decrease fall risk.
While aches and pains do occur from time to time, persistent and severe pain needs further evaluation. You may have an inflammatory condition that is just not being treated appropriately with over-the-counter medications.
What changes can I make at home to help my arthritis?
There are three big ones. Many rheumatic conditions, such as rheumatoid arthritis are more prevalent in smokers. You should work with your primary physician on smoking cessation. Diet also plays a large role with inflammation. I recommend a heart healthy diet, prepare your own food, and avoid any artificial or processed foods. Plant-based diets rich in whole grains, fruits and vegetables and low in saturated fats have been shown in some studies to improve inflammatory symptoms. You should try to avoid sugar and sugar substitutes, refined carbohydrates, cheese and high fat dairy and alcohol. Most important is exercise. Try to get moving 30 minutes a day, 5 days a week.
Dr. Dondero is experienced in the treatment of a wide variety of rheumatic autoimmune diseases ranging from rheumatoid arthritis, psoriatic arthritis, lupus and dermatomyositis, to gout and osteoarthritis. She sees patients at White Plains Hospital Physician Associates practices in Armonk, Larchmont and Yorktown Heights. For more information or to make an appointment, call (914)-849-7900.
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Dr. Stephanie Dondero is a rheumatologist seeing patients at the Armonk, Larchmont and Yorktown Heights locations. To make an appointment, call 914-849-7900.