The Rheumatology Division at New England Neurological Associates (NENA), P.C., offers a wide range of services for the diagnosis and treatment of diseases affecting the bones, joints and muscles, including arthritis.
What Does a Rheumatologist Do?
A rheumatology doctor is also referred to as a rheumatologist or a rheumatoid arthritis doctor. A rheumatology doctor is a board-certified pediatrician or internist who has postgraduate training related to the prevention, diagnosis and non-surgical treatment of rheumatologic disorders.
NENA’s Rheumatology Division Diagnoses and Treats:
- Rheumatoid arthritis, which is usually associated with severe joint pain and swelling.
- Degenerative, ‘wear and tear’ arthritis (i.e., osteoarthritis).
- Arthritis that develops in association with some type of inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease.
- Systemic inflammatory arthritis including psoriatic arthritis (PsA) and ankylosing spondylitis (AS).
- Bone diseases, such as osteoporosis.
- Joint pain.
- Musculoskeletal pain syndromes (e.g., fibromyalgia, myofascial pain syndrome, tendonitis).
- Local and systemic sclerosis (i.e., scleroderma).
- Raynaud’s phenomenon--Finger and toe color changes associated with pain especially when exposed to cold.
- Crystal-induced arthritis, which is also referred to as gout and CPPD arthritis (pseudo-gout).
- Diseases that cause the blood vessels to become inflamed (i.e., vasculitis). These diseases include hypersensitivity vasculitis, Wegener’s granulomatosis, cryoglobulinemia and giant cell (temporal) arteritis.
- Inflammatory diseases that involve the muscular system (e.g., dermatomyositis/polymyositis and polymyalgia rheumatica).
- Autoimmune diseases, such as Sjogren’s syndrome as well as various forms of lupus (e.g., systemic lupus erythematosus) and antiphospholipid syndrome
Arthritis and Rheumatology
A rheumatoid arthritis treatment plan is usually multifaceted.
A patient's arthritis treatment plan may include:
Disease-modifying anti-rheumatic drugs (DMARDs) – When treatment begins during the early stages of a disease, the rheumatologist may be able to use DMARDs to slow down or even stop the disease processes associated with the inflammatory forms of arthritis. Commonly used DMARDs include Trexall, Arava, Azulfidine and Plaquenil.
Biologic response modifiers – This is a newer class of disease-modifying anti-rheumatic drugs that work in conjunction with one of the conventional DMARDs. Biologic response modifiers include Orencia, Kineret and Humira.
Targeted synthetic disease-modifying anti-rheumatic drugs – These drugs are used when conventional DMARDS in conjunction with the biologic response modifiers have been ineffective. These medications include Olumiant, Rinvoq and Xeljanz.
Steroids – Medications such as oral prednisone and steroid injection help reduce the swelling that slowly damages the joint. Since the inflammation decreases, so does the patient's pain level.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) – Advil, Aleve and Motrin IB. When necessary, the rheumatologist can prescribe stronger NSAIDs.
Physical and occupational therapy – During these sessions, patients learn specific exercises designed to keep their joints flexible. In addition, new ways to complete daily tasks and reduce the amount of stress placed on the joints may also be explored.
Assistive device recommendations – Assistive devices include a knife with a handgrip to protect the joints of the wrist and hand while cutting, as well as buttonhooks to help the patient while dressing.
If these non-surgical, conventional treatments are ineffective, surgical intervention may be necessary. Since rheumatologists do not perform surgery, patients are referred to one of NENA's orthopedic surgeons.
Osteoporosis and Rheumatology
Osteoporosis is a disease that causes thinning of the bones. In order to help increase the density of the bones, a patient's osteoporosis treatment plan will include medication designed to increase his or her bone density.
These medications are taken to increase bone density.
Osteoporosis medicines include:
- Fosamax (Alendronate).
- Zometa (Zoledronic acid).
- Boniva (Ibandronate).
Taking these medications as prescribed reduces the likelihood of the patient experiencing side effects (e.g., abdominal pain, nausea).
Denosumab (Xgeva, Prolia).
Patients receive this osteoporosis treatment every six months via an injection.
Bone-building medications include:
- Tymlos (Abaloparatide) – This drug is similar to the hormones released from the parathyroid gland. The hormones the gland releases regulate calcium. Tymlos is injected daily. Its use is limited to two years.
- Forteo (Teriparatide) – This medication stimulates bone growth. It is administered via an injection. Use is limited to two years.
- Evenity (Romosozumab) – This drug is administered via a monthly injection. Use is limited to a year.
Once a patient stops taking bone-building medications, he or she will usually need to take another osteoporosis medication to maintain the new bone that grew in during the osteoporosis treatment.