Rheumatology Conditions We Treat

Ankylosing spondylitis is a long-term disease that causes inflammation of the joints between the spinal bones and the joints between the spine and the pelvis. It eventually causes the affected spinal bones to join together.

The cause of ankylosing spondylitis is unknown, but genes seem to play a role. The disease most frequently begins between ages 20 and 40, but may begin before age 10. It affects more males than females. Risk factors include a family history of ankylosing spondylitis and male gender.

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or oral disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or sulfasalazine, to reduce inflammation and pain. Drugs called TNF-inhibitors (etanercept, adalimumab, infliximab), which block an inflammatory protein, have been shown to improve the symptoms of ankylosing spondylitis. 

A connective tissue disease is any disease that has the connective tissues of the body as a primary target of pathology. The connective tissues are the structural portions of our body that hold the cells of the body together. These tissues form a framework for the body. The connective tissues are composed of two major structural protein molecules, collagen, and elastin. There are many different types of collagen protein that vary in amount in each of the body's tissues. Elastin has the capability of stretching and returning to its original length—like a spring or rubber band. Elastin is the major component of ligaments (tissues that attach bone to bone) and skin.

In patients with connective tissue diseases, it is common for collagen and elastin to become injured by inflammation. Many connective tissue diseases feature abnormal immune system activity with inflammation in tissues as a result of an immune system that is directed against one's own body tissues autoimmunity.

Giant cell arteritis (GCA) is a condition in which arteries in your neck, upper body and arms become inflamed. It is also called temporal arteritis, as it often affects the arteries near the temples, although it can involve arteries in just about any part of the body.

Some of the more common symptoms in GCA include headaches, pain in the jaw or tongue muscles when eating or talking and tenderness in the scalp over the temples. GCA is typically treated with high doses of corticosteroids. Oral immunosuppressant medications, such as methotrexate or cyclophosphamide, are often used as adjunctive therapies.

Gout is a painful and potentially disabling form of arthritis. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Treatments are now available to control most cases of gout, but diagnosing this disorder can be difficult and treatment plans often have to be tailored for each person.

Acute gout attacks are often treated with anti-inflammatory therapies such as NSAIDs, colchicine or corticosteroids. For long-term prevention of gout, uric acid-lowering agents such as allopurinol, probenecid, or febuxostat are used. 

Lupus or systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system and other organs of the body. Usually patients have skin rashes and arthritis, as well as fatigue and fever. Lupus attacks can vary from mild to severe, and usually alternate between periods of activity and periods when the disease is mostly quiet.

Lupus may be treated with several different types of medications depending on the organ(s) involved. For instance, musculoskeletal lupus symptoms are often treated with NSAIDs or anti-malarial medications such as hydroxychloroquine, while life-threatening lupus symptoms involving the kidney, lung or heart are often treated with immunosuppressive therapies such as corticosteroids, azathioprine, cyclophosphamide, or mycophenolate.

Myositis refers to inflammation of the muscles. Myositis involves chronic and/or persistent muscle inflammation, most commonly affecting the muscles around the hips or shoulders. Myositis may be associated with inflammation in other organs such as the joints, heart, lung, intestines, and skin. Myositis affects children between five and 15 years of age; most adults are affected between 30 and 60. Similar to other inflammatory rheumatic diseases, most forms of myositis affect more women than men.

Myositis is usually treated with oral immunosuppressant medications, including corticosteroids such as prednisone, methotrexate or azathioprine. In treatment-resistant cases, other immunomodulatory therapies such as intravenous immunoglobulin, mycophenolate or cyclophosphamide may be effective.

Polymyalgia rheumatica (PMR) is a disorder generally seen in people older than 50 that causes stiffness and aching in the neck, shoulder and hip areas. Other symptoms may include fatigue, weight loss, low grade fever and depression.

Polymyalgia rheumatica is typically treated with low doses of corticosteroids. Treatment-resistant cases may require immunosuppressant medications such as methotrexate.

Psoriatic arthritis is an arthritis that is often associated with psoriasis of the skin. Psoriatic arthritis is often treated with NSAIDs or oral disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or sulfasalazine. Biologic agents such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) offer excellent treatment options, since they also are effective in treating psoriatic skin disease.

While rheumatoid arthritis (RA) has long been feared as one of the most disabling types of arthritis, the outlook has dramatically improved for many newly diagnosed patients. Recent advances in treatment have made it possible to stop or at least slow the progression of joint damage. Some new therapies target inflammation, thanks to exciting and rapidly developing research in this area; others involve combinations of existing medications to help those who suffer from the disease. 

Several options exist for the treatment of rheumatoid arthritis, such as nonsteroidal anti-inflammatory drugs (NSAIDs); corticosteroids; oral disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, hydroxychloroquine or sulfasalazine; and biologic agents such as adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade), abatacept (Orencia), and rituximab (Rituxan). 

Scleroderma is a chronic, long lasting disease that can affect your skin, joints, blood vessels and internal organs. It is a rare disease that is characterized by hard skin. In fact, the word scleroderma means "hard skin." Scleroderma affects women three to five times more often than men. It is seen in children as well as the elderly, but usually starts between the ages of 30 and 50.

Medications traditionally used to treat other autoimmune diseases like rheumatoid arthritis and lupus often have little effect on scleroderma. However, medications such as angiotensin converting enzyme (ACE) inhibitors, glucocorticoids, and immunosuppressive medications such as cyclophosphamide and mycophenolate may be effective. New treatments include prostacyclin-like drugs (epoprostenol, treprostinol, iloprost), endothelin receptor antagonists (bosentan, ambrisentan), and PDE-5 inhibitors (sildenafil, vardenafil, tadalafil) which appear to be effective in pulmonary hypertension.

Sjogren's syndrome is an inflammatory disease that can affect many different parts of the body, but most often affects the tear and saliva glands. Patients with this condition may notice irritation, a gritty feeling or painful burning in the eyes. Dry mouth or difficulty eating dry foods, and swelling of the glands around the face and neck are also common. Some patients experience dryness of other mucous membranes (such as the nasal passages, throat, and vagina) and skin.

Treatment of Sjogren's syndrome often involves a multidisciplinary approach including application of artificial tears or saliva, plugging or blocking of tear ducts, drugs that stimulate saliva flow (pilocarpine or cevimuline), as well as immunomodulatory therapies such as hydroxychloroquine or other medications often used to treat lupus or rheumatoid arthritis.

Vasculitis refers to inflammation of blood vessels. There are multiple types of vasculitis, most are rare and the causes are generally unknown. Vasculitis can affect men and women, young and old. The wide range of symptoms seen in vasculitis reflects the potential for damage from poor blood flow to a variety of affected tissues throughout the body. For example, vasculitic damage to the lungs may cause shortness of breath and cough; damage to nerves may lead to numbness or weakness in a hand or foot; and damage to skin may produce red spots (purpura), nodules, or ulcers. On the other hand, vasculitis of the kidneys may produce no symptoms at first but is a very serious problem.

Treatment of vasculitis often involves high doses of corticosteroids as well as immunosuppressant medications such as cyclophosphamide or methotrexate. 

Wegener's granulomatosis (WG) is a rare blood vessel disease that can cause symptoms in the nasal sinuses, lungs and kidneys, as well as other organs. This is a complex and potentially serious disease. However, with prompt diagnosis, WG can be treated effectively.

Treatment of Wegener's granulomatosis often involves high doses of corticosteroids as well as immunosuppressant medications such as cyclophosphamide or methotrexate.