General Rheumatology

When hands change: Hand Arthritis

January 3, 2022 ·

“My hands are deforming just like my grandmothers.”

We don’t think about how much our hands do for us until they start giving us problems. We assume we will be able grip our steering wheel, type on our keyboards and button our shirts. But for many of us, usually in our 40’s (although it can start earlier), we start to notice changes in our hands. A day of work at our computer ends with our hands sore. We can’t quite open jars as easily as before and we may notice seemingly random shooting pains and numbness in our fingers. These symptoms can go unnoticed until we start noticing our hands LOOK different and rings don’t fit. Shoot….time to see a doctor!

When someone ends up in my office worried about their hands, I know their number one concern is Rheumatoid Arthritis (RA). A quick visit to Dr. Google, informs everyone that RA could cause hand pain and lead to “deformities.” For most of us with hand pain (including myself), RA will not be the culprit, but instead, osteoarthritis (OA).

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Discoid Lupus Explained

December 30, 2021 ·

Discoid lupus must be just like “regular” lupus, right? I mean, lupus is lupus, no? You’d think so, but like most things within Rheumatology, it rarely makes that much sense. When one speaks of “lupus” they are usually talking about SLE or Systemic Lupus Erythematosus. SLE is a systemic (affects the entire body), autoimmune condition. Discoid Lupus, or DLE, is a condition solely of the skin. One can certainly have “discoid lesions” when they have SLE and we are always on alert for the development of SLE, but rest assured, they are two different entities.

The name “discoid” stems from the description of the typical rash seen with DLE: a disc shaped, red patch with a scale and with scaring. It is common to worry about “progression to SLE.” Thankfully, development of SLE is the exception, rather than the rule. Although dermatologists are often the main caregivers of DLE, a full evaluation by a rheumatologist can provide insight and peace of mind.

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Pregnancy & Lupus

December 27, 2021 ·

I’ve sat down with hundreds of young women as they find out they have lupus. Once a diagnosis is made, the conversations are largely one-sided. Explaining what lupus is, how we diagnosis it, and what we are going to do about it can take a while. I’ve seen every possible emotion you can think of wash over the faces of women as they absorb this news: relief at an answer, sadness at what it means, anger at why them, and then fear for their future. The fear, for many, circles around concerns over the possibility of a pregnancy with lupus.

Lupus can affect anyone, but young women are the most commonly affected. Women in their teens, twenties and thirties, or what we call in medicine, the child-bearing years. Discussing issues related to pregnancy is a necessary component to a well-rounded lupus treatment strategy.

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Know the Prednisone Side Effects

December 23, 2021 ·

Let me be clear – I wouldn’t want to be on prednisone either. In fact, when suffering from a wicked case of vertigo, I fought my doctor buddies who advised I take a Medrol dose pack to ease the symptoms.

“I’m going to gain weight!” “I’m going to have anxiety!”

As a Rheumatologist, I am well-versed in all the possible side effects of prednisone (and similar meds) and feared the worse.

But I also know that there is a time a place for prednisone. Not only was I currently in need of the benefits of prednisone, many of my patients are as well. But there ARE side effects that need to be considered and discussed.

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Do you need Prednisone?

December 20, 2021 ·

“We are just wanting to know if we need to start steroids.”

Doctors will often make this comment when seeking out a rheumatology consultation. Prednisone has almost become synonymous with rheumatology. For years it was one of just a handful of treatments at our disposal to calm down the myriad of autoimmune and inflammatory conditions we came across. But the liberal use of prednisone by rheumatologists also served as education to all the harms the drug can cause.

When facing a prescription for prednisone, one can have many mixed feelings. Relief at the prospect of having some respite from pain and fear at the idea of all the side effects. Prednisone use has become so ubiquitous, especially with autoimmune disease, it can be easy to think of it as simply another “Tylenol” or “Advil.” But it needs to be understood and respected in order to be best used.

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