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 Frequently Asked Questions


What is a rheumatologist?

A rheumatologist is a doctor who diagnoses and treats arthritis and other diseases affecting joints, muscles and bones. A rheumatologist is a board certified internist, who then continues on for additional specialty training in a fellowship program for 2 years concluded by board certification in rheumatology at the completion of the fellowship. Rheumatologists treat arthritis pain and inflammation, autoimmune diseases, musculoskeletal disorders and osteoporosis. There are many conditions rheumatologists may treat and diagnose. Some of these conditions are Rheumatoid Arthritis, osteoarthritis, systemic lupus erythematosus, gout, osteoporosis, fibromyalgia, tendonitis and bursitis.


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What is the difference between Rheumatoid Arthritis and Osteoarthritis?

Rheumatoid Arthritis (rue-ma-TOYD arth-write-tis) is a chronic disease which is characterized by inflammation of the lining of the joints, called the synovium. This inflammation can lead to joint damage over time, resulting in chronic pain, and loss of joint function. Over one million Americans are afflicted with Rheumatoid Arthritis. Symptoms may include swelling, warmth of the joints, and prolonged stiffness especially in the morning. Commonly involved joints include the hands, wrists, knees and ankles. Treatments for rheumatoid arthritis aim to reduce inflammation, pain and prevent long term joint damage and loss of mobility. Rheumatoid arthritis is also characterized as being a systemic disease, which means it can affect other organs in the body. If you suspect you may have Rheumatoid Arthritis, early diagnosis is important, and you should be evaluated by a rheumatologist quickly. Many successful treatments are available for Rheumatoid Arthritis allowing for people to continue to do all the things they enjoy and love To find out more, go to Arthritis Foundation.

Osteoarthritis is chronic disease which is characterized by cartilage break down within the joint, often referred to as "degenerative joint disease" or "degenerative arthritis" or "wear and tear arthritis". As the cartilage wears away, the bones become exposed and rub against each other, often causing pain and difficulty with joint motions like stair climbing. Osteoarthritis is the most common type of arthritis, affecting approximately 33 million Americans. It is most common in people older than 65, but can affect people of other ages in certain circumstances including history of joint trauma or family disposition. Symptoms may include stiffness, particularly first thing in the morning, or after you have been resting a while. Common areas affected include the lower back, hips, knees, hands and feet. Treatments for osteoarthritis are aimed to ease pain and stiffness and make it easier to remain active. There are several treatment options available, which are often tailored for each individual patient. If you suspect you may have osteoarthritis you should consult with a rheumatologist for appropriate diagnosis and treatment. For more information, go to Arthritis Foundation.


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What is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Typically, small joints of the hands, wrists, ankles, feet and cervical spine are more commonly affected, but larger joints like shoulders, knees, and hips can also be involved. This produces a pattern of joint disease that rheumatologists regard as characteristic of Rheumatoid Arthritis. Although joints are primarily affected, inflammation can develop in other organs as well.

The stiffness seen in active Rheumatoid Arthritis is typically worst in the morning and may last anywhere from one to two hours to the entire day.

Other symptoms that can occur in Rheumatoid Arthritis include:

  • Loss of energy
  • Low-grade fevers
  • Loss of appetite
  • Dry eyes and mouth from an associated condition known as Sjögren’s Syndrome
  • Firm lumps called rheumatoid nodules beneath the skin in areas such as the elbow and hands


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What causes Rheumatoid Arthritis?

Rheumatoid Arthritis is classified as an autoimmune disease, which develops because certain cells of the immune system malfunction and attack healthy joints. The cause of Rheumatoid Arthritis remains unknown.


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Who gets Rheumatoid Arthritis?

Rheumatoid Arthritis is the most common form of inflammatory arthritis. More than 1 million Americans suffer from Rheumatoid Arthritis. About 75 percent of those affected are women, and 1–3% of women may develop Rheumatoid Arthritis is their lifetime. The disease most often begins between the fourth and sixth decades of life; however, Rheumatoid Arthritis can develop at any age.


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How is Rheumatoid Arthritis diagnosed?

Rheumatoid Arthritis is a clinical diagnosis. Symptoms, physical examination findings such as warmth, swelling and pain in the joints, and certain abnormal laboratory parameters can help in establishing a diagnosis.

The American College of Rheumatology has defined (1987) the following criteria for the classification of Rheumatoid Arthritis: At least four criteria have to be met for classification as Rheumatoid Arthritis and have to present for at least 6 weeks:

  • Morning stiffness of >1 hour most mornings
  • Arthritis and soft-tissue swelling of >3 of 14 joints
  • Arthritis of hand joints
  • Symmetric arthritis
  • Subcutaneous nodules in specific places
  • Elevated Rheumatoid factor
  • Radiological changes suggestive of joint erosion


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How is Rheumatoid Arthritis treated?

At present, there is no cure for Rheumatoid Arthritis. The goal of treatment is to minimize patient’s symptoms and disability by initiating medical therapy early on, before the joints become irreversibly damaged. There is no single therapy that is effective for all patients, and many patients will need to change treatment strategies during the course of their disease. Some patients may do well on just a single medication, while others may require multiple medications.

One class of medications commonly used to treat Rheumatoid Arthritis is called Disease Modifying Anti-Rheumatic Drugs (DMARDs). Some examples of these medications are hydroxycholoroquine (Plaquenil), methotrexate (Rheumatrex), sulfasalazine (Azulfadine), leflunomide (Arava), azathioprine (Imuran) and cyclosporine (Sandimmune or Neoral).

Another class of medications for Rheumatoid Arthritis treatment is called Biological Disease Modifying Anti-Rheumatic Drugs. These medications may work by targeting and inhibiting tumor necrosis factor (TNF), which is a substance responsible for inflammation in Rheumatoid Arthritis. Examples of these are infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira). These medications may be given in different ways. Infliximab is given by intravenous infusion, while etanercept and adalimumab are given under the skin as a subcutaneous injection. Abatacept (Orencia), is another class of biologics, given intravenously, which is approved for the treatment of Rheumatoid Arthritis. Abatacept works early in the Rheumatoid Arthritis inflammatory process at the T-cell (an immune cell) level and can reduce the activation of T cells, which reduces the activation of other cells in the Rheumatoid Arthritis inflammatory process. Rituximab (Rituxan) is an intravenous medication approved for Rheumatoid Arthritis. Rituxan selectively targets only CD20+ B cells (an immune cell as well). B cells are believed to contribute to the immune processes that lead to inflammation and joint damage. Patients must consult with their doctors prior to starting any of these medications.

This is only a short summary on Rheumatoid Arthritis provided for you as a starting point. It is always best to speak with your doctor for more information or prior to making any decisions about medications. You can also visit our Links and Resources section and click onto one of the websites for more information.


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What is Osteoporosis?

Osteoporosis is a disease of bone that leads to an increased risk of fracture. Osteoporosis occurs when the bone mineral density (BMD) is reduced and bone architecture is disrupted. The term “established osteoporosis” indicates the risk for a fragility fracture.


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Who gets osteoporosis?

Osteoporosis is most common in women after menopause. Osteoporosis may also develop in men, and may occur in anyone with specific hormonal disorders, particular chronic diseases or secondary to medications, specifically glucocorticoids. Patients with osteoporosis will require treatment which may involve lifestyle changes, preventing falls and the addition of medications such as calcium, vitamin D, bisphosphonates (ie Fosamax, Actonel, Boniva, and Reclast)


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How osteoporosis is diagnosed?

A simple test that measures bone mineral density (BMD) at different parts of your body, such as your spine and your hip, called a Dual energy x-ray absorptiometry (DEXA), which is a quick and painless test; it is similar to having an x-ray taken, but uses much less radiation. Even so, pregnant women should not have this test to avoid any risk of damaging the developing fetus. The results of the DEXA test are scored in comparison to the BMD of young, healthy individuals, resulting in a measurement called a T-score. If your T-score is –2.5 or lower, you are considered to have osteoporosis and therefore are at high risk for a fracture. T-scores between –1.0 and –2.5 are generally considered to show “osteopenia.” The risk of fractures generally is lower in people with osteopenia when compared with those with osteoporosis but, if bone loss continues, the risk for fracture increases.


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How osteoporosis is treated?

To maintain bone health:

  • Ensure adequate calcium in your diet (1000 mg per day of calcium for women before menopause and 1500 mg per day for women who are postmenopausal), unless otherwise specified by your doctor or advised to avoid calcium by your doctor.
  • Get adequate vitamin D intake, which is important for calcium absorption and to maintain muscle strength. Doses can be adjusted according to blood levels of vitamin D.
  • Get regular exercise, especially weight bearing exercise.
  • A number of medications are also used for the prevention and treatment of osteoporosis:
    • Bisphosphonates:
      • alendronate (Fosamax)
      • risedronate (Actonel)
      • ibandronate (Boniva)
      • zolendronic Acid (Reclast)
      Bisphosphates are used for treatment and prevention of osteoporosis in postmenopausal women. These medications help slow down bone loss and have been shown to decrease the risk of fractures.

      All are pills that must be taken on an empty stomach with a large glass of water. In order to minimize the potential for irritating the esophagus, patients are advised to remain upright for at least an hour after taking these medications. Bisphosphonates should not be used during pregnancy, in patients with low blood calcium levels, patients with renal or kidney impairment, in patients with an established diagnosis of esophagitis, in patients who have had an allergic reaction to any of the bisphonates, or in patients who are not able to remain in an upright position for at least one hour. Women should be advised not to become pregnant while taking any of the bisphosphonates because of potential harm to the fetus. Patients undergoing oral or dental surgery should consult with their doctors prior to starting these medications.

      Blood calcium levels should be monitored in all patients taking bisphosphonates.
    • Calcitonin (Calcimar, Miacalcin):

      This medication, a hormone made from the thyroid gland, is given usually as a nasal spray or as an injection under the skin. It is used for the treatment of postmenopausal osteoporosis and helps prevent vertebral (spine) fractures. It also is helpful in controlling pain after an osteoporotic vertebral fracture.
    • Teriparatide (Forteo):

      Teriparatide is a form of parathyroid hormone that helps encourage bone formation. It is currently used for treatment in postmenopausal women and men at high risk for osteoporotic fracture. It is given as a daily injection under the skin and can be used for up to 2 years. If you have ever had radiation treatment or your parathyroid hormone levels are already too high, you may not be able to take this medication.
  • Prevention
    • Lifestyle changes may be the best way of preventing osteoporosis.
    • Ensure adequate enough calcium and Vitamin D in your diet or by supplements.
    • Stop smoking.
    • Prevent excess alcohol intake.
    • Participate in weight-bearing exercises as tolerated.
    • Treat underlying medical conditions that can cause osteoporosis.
    • Minimize or change medications that can cause osteoporosis; never stop taking any medication without speaking with your doctor first.
    • If you are at high risk for falls, consider using hip protectors (e.g. SAFEHIP ®), which will help prevent a hip fracture if you fall.


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