Ground Breaking Therapies
Dr. David Mandel has been a practicing rheumatologist for more than 35 years.
He is considered one of Northeast Ohio’s thought leaders in the treatment of patients with arthritis and osteoporosis. His practice has been involved in the development of many new cutting edge therapies that are now available to help patients with the pain of arthritis.
We utilize the most current diagnostic studies and treatments for the care of our patients. Many newer medications are referred to as biologic therapies. These medications attack and are directed in a unique way to target some of the cytokines (molecules) that cause these rheumatologic diseases. These medications are either self-administered injections or given intravenously at a hospital or infusion center. We work closely with these facilities in the community so that your care can be easily administered.
The following articles provide a current overview of some of the more common types of arthritis seen in a Rheumatology practice.
Millions of patients have moderate and severe rheumatoid arthritis which causes significant stiffness, pain and swelling of joints. They may have difficulty doing simple tasks first thing in the morning such as squeezing toothpaste, grasping and taking lids off jars. They feel like ‘the tin man in the Wizard of Oz and could sure use a lube job’. Anti-inflammatory medicines may help the pain but do not slow the progression of joint damage and deformity.
Today there are medications like Methotrexate and Biologic therapies which target specific molecules that cause the disease and can give people ‘their life back’.
These medications have changed the way which we think about rheumatoid arthritis as no longer a ‘crippling’ illness but one that can be controlled and possibly cured.
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
Gout – Arthritis
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
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.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex, Naprosyn and Mobic may help alleviate some of the muscle and joint pain.
- 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
- 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.
- 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 intravenously and has shown to be quite safe and effective in improving quality of life and 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.
Raynauds is a constriction of the small blood vessels of the hands or feet. This occurs in cold temperatures. Raynauds is more common in women and people who have autoimmune diseases like rheumatoid arthritis, lupus ,sjogrens and scleroderma. The symptoms can be mild with discoloration or very painful. Often wearing good gloves or using hand or foot warmers is effective. There is also medication to improve circulation and relieve the pain.