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Ankylosing Spondylitis (AS) is an autoimmune disease in which the immune system attacks the joints causing inflammation primarily of the spine. It affects men more often than females and usually begins in the twenties and thirties. The most common symptoms are low back or neck pain associated with prolonged stiffness in the joints. Other areas of involvement can include the eyes, heart and lungs. It is important that you discuss your symptoms with your rheumatologist, as diagnosing AS can be very difficult.

While we do not know what causes AS, we do know that family history and some environmental exposures can increase the risk of getting this disease. We have several very effective treatments available to help ease the pain and disability from this autoimmune condition.

Bursitis is an inflammation of the small sacs of fluid that lie between the tendons and bones. Swelling in these areas put pressure on the surrounding structures and cause pain. There are many bursae in the body. The most common sites of bursitis include the area around the shoulder, hip and elbow.

Tendonitis is inflammation as a result of injury to a tendon. Common areas include the shoulder, elbow, knee and ankle. Symptoms can vary from pain and localized stiffness to a burning sensation. Full improvement is seen between four to six weeks with initial improvement occurring after two to three days.

Treatment for both conditions includes rest, ice and medication to decrease the swelling. If these are not effective, a steroid injection into the area can be given. Stretching and/ or strengthening exercises should also be used to prevent weakness in the surrounding joints and muscles.

C.R.E.S.T. is a limited form of systemic sclerosis (scleroderma), a chronic autoimmune disease that leads to the hardening and tightening of the skin and connective tissues. The acronym C.R.E.S.T. stands for five key features of the condition:

C – Calcinosis: Calcium deposits under the skin, often seen in fingers, elbows, or knees.

R – Raynaud’s Phenomenon: A condition where fingers or toes turn white or blue in response to cold or stress due to blood vessel spasms.

E – Esophageal dysmotility: Problems with the muscles of the esophagus that cause difficulty swallowing or acid reflux.

S – Sclerodactyly: Thickening and tightening of the skin on the fingers or toes, which can reduce mobility.

T – Telangiectasia: Small, visible red blood vessels on the face, hands, or inside of the mouth.

Symptoms vary depending on the organs involved. In most cases, C.R.E.S.T. affects the skin and gastrointestinal system, but it can also impact the lungs or heart in more advanced stages.

Treatment is focused on managing individual symptoms and preventing complications. This may include medications for circulation, acid reflux, or immune suppression, as well as physical therapy. Your rheumatologist will guide treatment based on your specific symptoms and disease progression.

Fibromyalgia is a chronic disorder that causes diffuse muscle pain and body stiffness in all four quadrants of the body. It is most common in women under age fifty. While we do not know what causes fibromyalgia, we believe there is a problem with certain hormones in the brain that makes a person experience pain differently. Fibromyalgia patients usually have a lower threshold for pain.

Other symptoms commonly seen with fibromyalgia include migraine headaches, fatigue, carpal tunnel syndrome, irritable bowel syndrome and poor sleep. Anxiety and depression also tend to accompany this disease. Cognitive behavioral therapy from a psychologist or psychiatrist is beneficial. Referral to a physical therapist is also important in managing this condition. Notably, an aqua program (walking in water) is considered one of the best forms of exercise for this condition.

Your rheumatologist will examine your body for tender points that are linked to this condition. To date, there is no blood test, x-ray or other imaging test that can detect fibromyalgia, the diagnosis is made after excluding other types of arthritis.

In many cases, more than one specialist is required to assist in treating this illness. Your rheumatologist can recommend a combination of medications that can improve sleep and function while decreasing widespread pain.

Joint pain may be a sign of osteoarthritis, injury or overuse, an inflammatory process or a chronic pain syndrome. Different types of arthritis affect different parts of the body. The location of the pain as well as the symptoms that help or worsen the joint pain are important pieces of information that can help in making a diagnosis. Patient age and family history also contribute to various types of arthritis. Your rheumatologist will ask you questions and examine you to best determine the reason for your pain. It is important to determine the cause of your joint pain before selecting a treatment plan.

Myositis refers to a group of rare conditions characterized by inflammation and weakness of the muscles, most often those closest to the center of the body such as the shoulders, hips, and thighs. Common types of myositis include polymyositis, dermatomyositis, inclusion body myositis, and juvenile myositis. In some cases, myositis may also be triggered by infections, certain medications (such as statins), or autoimmune responses.
Symptoms vary between individuals but commonly include muscle weakness, fatigue, difficulty climbing stairs or lifting arms, and, in some types, skin rashes. In more advanced cases, swallowing and breathing muscles may also be affected.
Treatment depends on the type of myositis, its severity, and the underlying cause. Options may include corticosteroids, immunosuppressive medications, physical therapy, and in some cases, biologic therapies. Your rheumatologist will evaluate your symptoms and lab findings to recommend the most effective treatment plan to help manage your condition.

Pseudogout has very similar symptoms to gout. It is an extremely painful arthritis with sudden swelling and pain in the joint. The crystals that cause these painful crises are made up of calcium pyrophosphate dehydrate (CPPD) instead of uric acid. The most common site is the knee but other joints can also be affected. Taking a small amount of fluid from an affected joint and finding these CPPD crystals under a special microscope confirms the diagnosis.

Both men and women have a similar chance of getting pseudogout. It is also common in patients who have osteoarthritis, thyroid problems, kidney failure or other diseases that affect calcium, phosphate or iron metabolism.

Anti-inflammatory medicines are often prescribed to treat these sudden attacks. Likewise, steroids may be injected directly into your joint to calm the inflammation. Without treatment, symptoms can last 5 to12 days but with treatment, symptoms can improve within 24 hours.

Scleroderma is a rare autoimmune disease in which the body attacks itself and causes thickening of the skin and connective tissue. Contrary to most autoimmune diseases there is no inflammation. It is more common in women than men and the cause is unknown. There are two forms: limited scleroderma and diffuse scleroderma. The limited form can cause a host of symptoms referred to as “Crest”. These include calcium deposits in the skin (C), blue discoloration of the fingers known as Raynaud’s (R), difficulty swallowing or esophageal dysmotility (E), tapering of the fingertips known as sclerodactly (S), and broken blood vessels on the skin known as telangectasias (T). The diffuse form usually involves a greater amount of skin thickening and may cause kidney and lung disease in later stages.

Diagnosis is made by assessing the symptoms along with physical exam findings. Blood tests are also used and best interpreted by a rheumatologist. Treatment is aimed at relieving the symptoms as there is no cure. Patients with either form of scleroderma should be monitored by their rheumatologist regularly so that the late complications of this disease may be identified and treated.

Vasculitis refers to a group of diseases in which there is inflammation and destruction of the small, medium or large blood vessels in the body. These include Giant Cell Arteritis (Temporal Arteritis), Takaysu’s Arteritis, Granulomatosis with Polyangiitis (Wegener’s), microscopic polyangitis, Churg-Strauss Syndrome, Henoch-Schonlein purpura and cutaneous vasculitis. Infections, cancer and even drugs can produce symptoms of a vasculitis.

Symptoms vary from one person to another, however, fever, weight loss, fatigue and rashes are common. Organs that can be affected include the eyes, lungs, kidneys, skin and nerves depending on the type of vasculitis.

Treatment is based on the severity of the illness and organs affected. Some types of vasculitis can improve on their own and are considered to be self-limited while others can be very aggressive and lead to kidney failure or blindness. Your rheumatologist will evaluate you and decide the best treatment to control your disease.