Mystery Diagnosis? It May be Time to See a Rheumatologist

Rheumatologists are highly skilled in the diagnosis and nonsurgical treatment of rheumatic and autoimmune diseases. There are more than 100 such conditions, including rheumatoid arthritis and osteoarthritis, other disorders that cause muscle and joint pain ...

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One morning, actress Joanna Bonaro woke up and couldn't move the fingers in her left hand. "It happened out of the blue. My fingers were painful and swollen," explains Bonaro, who has had guest roles on several hit TV shows, including "The Sopranos" and "Law and Order SVU." She suspected her problem might be rheumatoid arthritis, since it runs in her family.

She quickly made an appointment with her general practitioner, who referred her to Dr. Ted Fields, a rheumatologist at Hospital for Special Surgery in Manhattan. Bonaro was correct in her own diagnosis. Rheumatoid arthritis, also known as RA, was confirmed through a blood test.

That was seven years ago. Today, Bonaro, who lives in Manhattan, keeps up a very busy schedule of acting jobs and auditions. She considers herself lucky. Early diagnosis and treatment have prevented the RA from getting worse.

She receives intravenous infusions of medication every couple of months to keep the disease in check. "It can surface in different joints at different times. After the infusions, the pain disappears overnight," she says.

When Bonaro first started having problems, her doctor immediately referred her to a rheumatologist, a medical doctor specializing in rheumatic diseases such as RA. She believes his care has enabled her to lead the active life she enjoys.

"Some adults with RA and other rheumatic diseases are treated by their primary care physician, generally an internist or family doctor," says Dr. Mary Crow, physician-in-chief and chair of the division of rheumatology at Hospital for Special Surgery. "However, many people would do well to make an appointment with a rheumatologist, especially if their condition is not improving."

A rheumatologist is a medical doctor who has completed advanced training in the field of medicine called rheumatology. To become a specialist in this area, internists or pediatricians go on to complete two or three years of additional Fellowship training in rheumatology.

These specialists are highly skilled in the diagnosis and nonsurgical treatment of rheumatic and autoimmune diseases. There are more than 100 such conditions, including rheumatoid arthritis and osteoarthritis, other disorders that cause muscle and joint pain and inflammation, osteoporosis, tendonitis, gout, lupus, scleroderma, vasculitis and Lyme disease.
Rheumatic diseases are the leading cause of disability in the United States, according to the Centers for Disease Control and Prevention. Early diagnosis and treatment, as well as lifestyle changes in some cases, are important to keep symptoms from getting worse.

"Some are very serious or rare diseases that can be difficult to diagnose and treat," Dr. Crow notes, "and patients can go for years without the right diagnosis. Rheumatologists are specially trained to do the detective work necessary to discover the cause of a patient's symptoms. These specialists are also aware of the latest treatments and newer medications that can provide relief. Generally, the sooner the treatment is started, the better the outcome."

The following are good reasons to see a rheumatologist, according to Dr. Crow:
If an individual has an unclear diagnosis or would like a second opinion
If someone has unexplained or persistent musculoskeletal pain
Anyone with persistent fevers that are not diagnosed
Someone whose symptoms are not improving, despite treatment
Individuals with abnormal laboratory findings
Patients who have normal laboratory results, but still have joint pain or swelling
Anyone who has an unexplained group of symptoms including fatigue, rash, fevers, arthritis, anemia, weakness or weight loss

"Years ago, rheumatoid arthritis was one of the most disabling diseases, but now 95 percent of patients can get good control of RA with the right medication," says Dr. Fields, Bonaro's physician. "But it sometimes takes trial and error to find the drug that will work for them, and that's where the skill and training of a rheumatologist are indispensable."

It's a misconception that if someone can tolerate RA symptoms or some other type of pain caused by inflammation, it's fine to forgo treatment, Dr. Crow says. "Over time, the disease can damage joints and tendons and lead to deformity. If you catch RA early, you can delay or prevent damage and avoid surgery."

Medications are most effective when the disease is in its early stages. The medicine stops the inflammation, and pain decreases dramatically for most patients.

Physicians may also prescribe physical therapy, certain exercises and other lifestyle changes, depending on the illness. Dr. Crow notes that a good rheumatologist is skilled in providing the specialized treatment that will improve quality of life and restore function so people can live their lives to the fullest.

Bonaro recently appeared in a PBS documentary film, portraying an Italian seamstress caught in the fire in the American Experience -"Triangle Fire." Bonaro is in such good shape, she is also one of the actors working out in an exercise DVD due out at the end of the year.

"When you take care of the disease, you can live your life as you choose," Bonaro says. "Without the infusions, it could stop me cold... but you can stop it in its tracks instead of seeing it cripple you."

For more information about rheumatic conditions or to find a rheumatologist at Hospital for Special Surgery, visit: