Elizabeth

Know the facts: Rheumatoid Arthritis (part 1)

July 21, 2021 ·

When getting a new diagnosis of Rheumatoid Arthritis, I find that most people need to start with the basics. It can be overwhelming. I know that not much beyond “You have Rheumatoid Arthritis” is heard and that everyone will need time to digest all the information out there.

So let’s talk about some Rheumatoid Arthritis facts and start with “What is Rheumatoid Arthritis?” RA is an autoimmune, systemic, inflammatory disorder. Seen in almost 1% of the US population, RA is more often seen in women compared to men and usually happens during middle age.

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Know the facts about Ankylosing Spondylitis

June 29, 2021 ·

I had to learn to always have a “high level of suspicion” for Ankylosing Spondylitis (AS) while a rheumatologist-in-training. This meant, I needed to “unlearn” most of what I was taught about back pain as an internal medicine resident. As an internist or primary care provider, you see a lot of patients with back pain. It is very common. In order to keep costs down and not overly worry patients, doctors are trained to treat back pain with common anti-inflammatory medications before jumping to x-rays and MRIs. And this isn’t JUST to keep costs down. The overwhelming majority of those with back pain will have resolution of that pain within 2 months. Hence, doing an MRI on every patient just doesn’t make sense. But as a rheumatologist, we are trained to look at back pain differently.

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Raynaud’s Syndrome

June 23, 2021 ·

(Pause while everyone looks down at their own nails)

I learned to include this little pause during my medical student lectures on Raynaud’s Syndrome and Scleroderma. As opposed to many of the other conditions I treat and teach, there is actually a very high likelihood that a handful in the audience will have Raynaud’s. This isn’t surprising given how common it is, especially amongst women between the ages of 15 and 30. It is when discussing the connection between Raynaud’s and Lupus or Scleroderma, that the wave of concern washes over some faces in the audience. What the audience members are looking for are changes in the nail bed capillaries. These changes, can be a sign that their Raynaud’s Syndrome is part of a larger autoimmune condition. Thankfully, most, if not all, will have perfectly normal nail bed capillaries and be able to sit through the rest of the lecture panic-free. But it is always a reminder that even when speaking to trainees and students, I am speaking to patients.

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Know the facts about your dsDNA antibody

June 15, 2021 ·

Most lupus patients are familiar with the dsDNA antibody blood test. Like the ANA result, it is a blood test most closely related to lupus. Occasionally a positive dsDNA result can be seen in other conditions. But, the presence of a dsDNA antibody is considered specific for a diagnosis of lupus. As there are multiple ways a lab may detect a dsDNA, there still remains the possibility of a false positive, but a positive dsDNA result warrants a trip to the rheumatologist. (Reminder = “false positive” simply means the test is positive, yet the patient doesn’t have the condition associated with that result) Patients often are referred to a rheumatologist with a notebook full of labs, mostly of all varieties of antibodies and it is overwhelming.

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What is Scleroderma?

June 8, 2021 ·

“Please don’t google this until we have more information.”

That’s not something I often say to my patients. I usually write out diagnoses and treatments, specifically so patients CAN google and research them. The internet is a wild place but I still stand on the side of more information is better than less. Yet, when it comes to scleroderma, I take a different approach. I want to make sure my patients have 1) the right diagnosis and 2) an appropriate perspective on their diagnosis before engaging with, what can be, the scary world of scleroderma online. Because I also know that a scleroderma diagnosis doesn’t have to be that scary.

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