Ground Breaking Therapies

Ground Breaking Therapies

Dr. David Mandel is one of Northeast Ohio’s thought leaders on the treatment and evaluation of patients with arthritis and osteoporosis. He utilizes new technologies and treatments that are truly cutting edge. These injection and infusion therapies have given patients their lives back. You wouldn’t expect to find these types of ground breaking therapies being used in a private practice, but Dr. Mandel is committed to providing only the very best care for its patients utilizing emerging treatments.

Rheumatoid Arthritis

Today, millions of patients with very active rheumatoid and other types of inflammatory arthritis receive some of the following injection and intravenous medications weekly or monthly. These medications have been shown to offer tremendous relief of joint pain and also can prevent further destruction of joints. No longer do we think of rheumatoid as the crippling arthritis but as a arthritis that can be “possibly cured.” Some patients have felt they finally have gotten their life back. Others say they now feel like their “good ole’ selves.” Learn more about these new Biologic medications by going on the following medication websites:

Links: Actemra, Cimzia, EnbrelHumira, Orencia, Remicade, Rituxan, Simponi

There is more helpful information about Rheumatoid Arthritis ;its causes how diet , and exercise can help control this illness by going to the site listed’ papers . There are some promising new oral therapies that work like the medications listed above in research trials that we are participating in at our Mayfield Village office. The names of a couple are Fostamatib and Tofacitnib which block some important chemicals involved in the cause of pain and inflammation of Rheumatoid Arthritis.

Osteoporosis

Today, there are many excellent medications that can reduce bone loss and prevent fracture. Osteoporosis can lead to serious consequences including spine and hip fractures. The pain can be very severe but can also cause both physical impairment of muscle weakness, deformity and emotional discomfort. Today there are many excellent medications that can prevent bone loss. Some patients have difficulty with gastrointestinal upset and can not easily swallow the common oral medications. They come to the office for intravenous or injections medications and strengthen their bones. Patients tolerate the medications quite well. These help reduce the risk of fracture significantly. First Line Therapies are oral bisphosphonates: Actonel, Atelvia, Boniva, and Fosamax.
Learn more about these by going on the following medication websites:

Actonel, Atelvia, Boniva, Forteo, Prolia, Reclast

Dupuytrens Contracture

This is a progressive abnormal thickening of tissue in the palm of the hand. Over time, this can form a thick tight cord which causes a bend in the fingers. Once this occurs, patients begin having difficulties such as combing their hair, brushing their teeth holding a tennis racket or golf club. In the past, surgery would be the only available treatment. Photo and information (pdf).  Today, there is an effective non surgical injection of a new medicine called Xiaflex. Studies have shown this to be very helpful, safe and with less time away from work and at a lower cost than surgery. Dr Mandel is one of a few Rheumatologists in the United States trained to administer Xiaflex.

Click here to learn more about Xiaflex

Systemic Lupus Erythematosis (S.L.E.)

Systemic lupus is a chronic inflammatory disease that can cause many different symptoms including pain and swelling of the joints, skin rashes and at times more serious internal organ disease. SLE is at times an elusive disease to diagnose. There are a number of laboratory tests which are very helpful in confirming the diagnosis, as well as monitoring treatment.

The American College of Rheumatology has established the following criteria which is listed for a diagnosis of lupus. This has been very helpful in clarifying an illness like lupus from other autoimmune diseases such as rheumatoid arthritis, Sjogren’s syndrome or vasculitis.

The treatment of lupus is dependent upon the specific clinical symptoms and laboratory tests that are present.

Some of the common medications used to treat lupus are listed below.

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex, Naprosyn and Mobic may help alleviate some of the muscle and joint pain.
  2. Anti-malarial drugs. Medications such as hydroxychloroquine (Plaquenil) and chloroquine phosphate (Aralen) are the most commonly prescribed and may be very useful for not only muscle and joint pain but also skin rashes.
  3. Corticosteroids. Prednisone is sometimes used for short periods of time as a bridge therapy when patients are having a flare.
    The goal is often to avoid using prednisone for longer periods of time because of the potential side effects which might include cataracts, thin skin, thin bones (osteoporosis) and diabetes.

  4.  Immunosuppressives are often prescribed to patients with lupus who have internal organ involvement. This might include low dose weekly Methotrexate or Arava.

Lastly, Benlysta or belimumab has recently been approved for the treatment of flares of lupus in patients who have been refractory to some of the stronger medications.

This new therapy is administered as an intravenous infusion and has shown to be quite safe and effective allowing many patients who have been on prednisone for long periods of time to be able to safely reduce the dose of corticosteroids or discontinue them completely.Click here to learn more:  benlysta.com

Gout

Gout is the most common inflammatory form of arthritis surpassing that of rheumatoid arthritis in the past few years. Many people mistakenly do not associate gout as a type of arthritis but a condition of pain the big toe . The attacks of gout are characterized by explosive and sudden onset of pain and redness about usually the great toe or instep of the foot but can involve any joint.
[See Photo] [See Photo 2]

There are many effective treatments to relieve the acute pain and eliminate this excessive burden of uric acid in the joint. These include Colcrys[Colchicine ] for prevention and Allopurinol and Uloric which eliminate uric acid from the body .

Avoiding foods and alcoholic beverages that our high in uric acid is crucial .

Our practice has been involved in helping to establish new guidelines for both the diagnosis and treatment of arthritis. On our website has a recent paper referring to these guidelines that I was one of the contributing authors. [Papers]

Musculoskeletal ultrasound is used for evaluating and diagnosing patients with many types of arthritis including gout . As you look at these photos of patients with deposits of uric acid in and around their joints, we can now very quickly confirm and establish that gout is the correct diagnosis. [See photo]

A new biologic infusion drug, Krystexxa, that has been approved for the treatment of chronic gout in patients refractory to conventional oral treatment. I would refer you to our website which has some remarkable photos of patients who had large amount of uric acid in and around their joints referred to as tophi .These virtually dissolved and were effectively treated by infusions of this new therapy.

Click here to learn more about KRYSTEXXA

INFUSION THERAPY

The fact that infusion therapy is an integral part of a treatment plan for patients either with arthritis or osteoporosis is not unusual. What is unusual is being able to receive the treatment right in the same office as your treating Rheumatologist.

Dr. David Mandel felt it was important to be able to have hands on with the patients in his practice when receiving therapy. Many times hospital infusion units are unfamiliar with the medications used in rheumatology and therefore do not have the specialized understanding that our infusion nurses have.

The environment is also important. Patients find sharing the same symptoms—physical, social and family issues—can act as another type of healing balm. The infusion process can be lengthy in the hospital units where patients could wait anywhere up to two hours before the IV is started. Hospital expenditures are quite a bit higher for this service opposed to having it rendered in the doctor’s office. Perhaps the most important impact is in the ability to monitor the patient first hand, see their response and tolerance to the medication.

Our infusion staff is highly professional, very dedicated, and is attentive to patients’ needs. This service is just another way Dr. Mandel works to make sure our patients receive the best quality care possible.

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