Ground Breaking Therapies
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.
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
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
The names of a couple are Fostamatib and Tofacitnib which block some
important chemicals involved in the cause of pain and inflammation of
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:
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
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
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
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 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
Click here to learn more:
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
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
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
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
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
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.