Rheumatology: dealing with inflammation

Dr. Nicole Cotter is a board-certified rheumatologist at UCHealth Rheumatology Clinic in Steamboat Springs. Photo courtesy UCHealth.

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From rheumatoid arthritis to lupus, rheumatologists treat a wide range of diseases. But the diseases have one common thread: inflammation.

“Rheumatology is a confusing specialty to many people, but the easiest way to think about it is that we’re the doctors of inflammation,” said Dr. Nicole Cotter, a rheumatologist with UCHealth Rheumatology Clinic in Steamboat Springs.

Rheumatologists manage ‘systemic autoimmune diseases,’ or diseases that affect many organ systems and result from the immune system attacking a person’s own body.

“It’s like the immune system gets confused,” Cotter said. “It starts to create inflammation in organs where there’s not a problem, and because of that inflammation, damage can occur.”

The list of diseases that rheumatologists diagnose and treat includes rheumatoid arthritis, lupus, inflammatory myopathies, vasculitis, gout, Sjogren’s syndrome and osteoarthritis.

As with other autoimmune diseases, it isn’t clear what causes rheumatological diseases. There is likely a genetic component as well as an environmental trigger, such as an infection, a dietary issue or an environmental toxin.

The most common symptom of rheumatological diseases is joint pain. But during the extensive physical exam Cotter conducts, in which she also takes a detailed patient history and reviews family history, she sometimes finds other symptoms.

“We might pick up on things the patient doesn’t realize are going on,” Cotter said. “They may come in for a swollen joint, then I’ll say, ‘What about this rash behind your ear?’ Or, I’ll ask if they’ve had muscle weakness and they’ll say, ‘Yes, actually, over the past few years it’s been hard getting out of my chair.”

It’s important not to ignore symptoms of any rheumatological disease, as early treatment is key. For instance, data shows that people with rheumatoid arthritis who are diagnosed early and treated aggressively do better over the long-term.

“Early diagnosis and early intervention is of the utmost importance,” Cotter said. “A lot of times people with joint pain will think, ‘I’m getting older,’ or ‘I was just aggressive with my workout yesterday.’ But I’d rather someone get checked out and find nothing is wrong, than for someone to wait two years and, by the time the issue is found, learn there’s already been damage to the joint.”

Lab tests alone cannot diagnosis or exclude a rheumatological disease. Someone may have antibodies that signal a possible issue and not have a disease, while someone else with a normal lab test may actually have a disease.

“There isn’t one thing that can tell me ‘yes’ or ‘no,'” Cotter said. “It really is putting a puzzle together and getting enough evidence that there’s a problem.”

When treating rheumatological diseases, the goal is management and remission. Medications play an important role in helping to suppress the abnormal immune response.

“The last twenty years have seen the advent of biologic drugs, which are targeted therapies that work on specific parts of the inflammation pathways,” Cotter said. “They’ve revolutionized the management of these diseases.”

Lifestyle changes are also key, including adjusting diets and reducing stress.

And while a diagnosis can feel daunting, there is hope.

“People with rheumatoid arthritis can come in feeling awful – their joints are swollen, they have trouble walking and doing daily tasks, they’re tired and feel wiped out. A lot of people are afraid that this is going to be their life,” Cotter said. “But we absolutely have treatments to get people feeling better and functioning better. Our goal with management of these diseases is to get you back to where you were the day before it started.”

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