California Rheumatology & Wellness

California Rheumatology

• Treatment of Arthritis and Autoimmune Disease

  Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is a common form of arthritis caused by the wearing down of the cartilage that protects the bones of a joint. Rheumatoid arthritis is an autoimmune condition caused by an inflammation in the lining of the joints. Both forms of arthritis cause pain, tenderness, and swelling, and may result in loss of movement in the affected joints. Over time, joints affected by arthritis may become severely damaged. Arthritis occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of a joint or after an injury. It can however, affect people of any age, including children. In addition to rheumatoid arthritis and osteoarthritis, there are other types of arthritis, and depending on the cause, may affect people of different ages. Gout is a form of arthritis caused by a build-up of uric acid within the body, that causes painful, swollen, red and inflamed joints. Psoriatic arthritis affects people who have psoriasis, a skin condition characterized by red and scaly patches of skin. Psoriatic arthritis is considered an autoimmune disorder and causes joint inflammation, stiffness and pain. We also treat other autoimmune diseases, such as the following: Systemic lupus erythematosus (SLE) Sclero Sjogren's Vasculitis Dermatomyositis Polymyositis Mixed Connective Tissue Disease (MCTD) Overlap Syndromes DIAGNOSTIC MODALITY Arthritis and autoimmune diseases are diagnosed through a combination of physical examination, diagnostic tests and imaging exams to evaluate the affected areas of the body. Diagnostic tests may include: Blood tests Urinalysis Joint fluid testing X-rays MRI scans Ultrasound may be performed to assess early inflammatory damage within the joints. TREATMENTS Treatment for arthritis and autoimmune disease varies based on the type and symptoms. Treatment may include medication to control pain, minimize inflammation, and slow the progression of joint damage. In severe cases, surgery may be recommended to repair tendons or replace damaged joints. In addition to medical treatment, some forms of arthritis may respond to lifestyle changes such as losing weight, eating a healthy diet and exercise. Heat and cold therapy may also relieve pain and swelling in joints and assistive devices such as canes or walkers may assist individuals with arthritis with mobility. Fortunately, we have a gamut of treatment options for both osteoarthritis and inflammatory arthritis. There are several medications called Disease-Modifying Antirheumatic Drugs (DMARDs) which are taken orally, as well as injections and infusions.

  Link: Treatment of Arthritis and Autoimmune Disease

• In-House Infusion Therapy

  Infusion therapy is the delivery of medication through a catheter intravenously for the treatment of rheumatic and autoimmune diseases, and may be used when appropriate to help prevent joint damage and the progression of diseases. There are several intravenous medications that are FDA approved for the treatment of autoimmune diseases. The use of these medications through infusion therapy have been successful in preventing joint deformities and improving overall outcomes in patients for autoimmune diseases, such as the following: Rheumatoid arthritis Psoriatic arthritis Systemic lupus erythematosus Ankylosing spondylitis Osteoporosis Crohn’s Gout Therefore, we provide in-house infusion therapy for our patients when the administration of oral medications is ineffective in treating their condition. Our skilled medical staff directly administer the infusions on-site and monitor our patients in a safe and comfortable environment.

  Link: In-House Infusion Therapy

• Musculoskeletal Ultrasound

  Ultrasound imaging uses sound waves to produce pictures of muscles, tendons, ligaments, nerves and joints throughout the body. It is used to help diagnose sprains, strains, tears, trapped nerves, arthritis and other musculoskeletal conditions. Ultrasound is safe, noninvasive, and does not use ionizing radiation. This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. ultrasound scaled 1 WHAT IS ULTRASOUND IMAGING OF THE MUSCULOSKELETAL SYSTEM? Ultrasound is safe and painless. It produces pictures of the inside of the body using sound waves. Ultrasound imaging is also called ultrasound scanning or sonography. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use radiation (as used in x-rays). Because images are captured in real-time,they can show the structure and movement of the body's internal organs. They can also show blood flowing through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Ultrasound images of the Musculoskeletal system provide pictures of muscles, tendons, ligaments, joints, nerves and soft tissues throughout the body. WHAT ARE SOME COMMON USES OF THE PROCEDURE? Ultrasound images are typically used to help diagnose: tendon tears or tendinitis of the rotator cuff in the shoulder, Achilles tendon in the ankle and many other tendons throughout the body. muscle tears, masses or fluid collections. ligament sprains or tears. inflammation or fluid (effusions) within the bursae and joints. early changes of rheumatoid arthritis. nerve entrapments such as carpal tunnel syndrome. ganglion cysts.

  Link: Musculoskeletal Ultrasound

• Ultrasound Guided Joint Injections

  Joint injections are a minimally invasive treatment for relieving pain caused by inflammatory joint conditions such as rheumatoid arthritis, tendonitis, bursitis and gout. To reduce pain and inflammation from these conditions, medications such as corticosteroids and hyaluronic-acid preparations are sometimes injected into the problem joint. The medications affect only the targeted areas, and usually do not cause side effects. Joint injections are administered under local anesthesia, and cause only brief, mild discomfort. To ensure precise administration of, and effective results from, joint injections, they are often performed under ultrasound guidance. Ultrasound uses high-frequency sound waves to produce real-time images of the internal structures of the body; no radiation is involved and there are no side effects. As with traditional injections, ultrasound-guided injections are made with standard needles and syringes. The difference is that, during ultrasound, a probe attached to a monitor is placed against the skin in the target area; this gives the physician an internal view of the joint to be injected. The physician watches the monitor as she or he places the needle into the joint, ensuring precise placement. Joint injections can be used to relieve pain in the following areas: Knee Shoulder Ankle Elbow Wrist Thumb Hip Unless they have joint infections or allergies to the medications used, most people are candidates for ultrasound-guided joint injections, which generally take between 15 and 30 minutes to perform.

  Link: Ultrasound Guided Joint Injections

• 

  Platelet Rich Plasma Therapy

  Certain elements within the blood, specifically the platelets, help tissues to heal by stimulating a repair and growth response. Platelet-rich plasma (PRP) injections promote accelerated healing by supplementing the platelet content of an area in which tissue has been damaged. WHAT IS PRP? PRP is plasma with a high concentration of platelets. Platelets, most commonly associated with clotting, can also assist in mending and strengthening damaged tissues by increasing certain growth factors at the site. WHAT ARE PRP INJECTIONS USED FOR? PRP injections can be used to treat a wide range of orthopedic conditions, including arthritis, tendonitis, tendinosis, chronic or postsurgical joint pain, bursitis, ligament tears or sprains, and nerve inflammation. They are also sometimes used to speed healing after non-orthopedic surgeries, especially cosmetic procedures. HOW DO PRP INJECTIONS WORK? PRP injections are usually administered in the doctor's office, under local anesthesia, with the assistance of ultrasound imaging. A small amount of blood is withdrawn from the patient and separated into its composite elements in a centrifuge. A rich concentration of platelets, up to five times the concentration found in natural blood, is then injected into the patient at the site of the damaged tissue. HOW LONG DO PRP INJECTIONS TAKE? Each procedure takes under an hour. Most patients require up to three PRP injections, about 4 to 6 weeks apart, in order to achieve optimal results. Occasionally, a fourth injection is necessary. WHAT HAPPENS AFTER THE PRP PROCEDURE? Most patients experience little or no discomfort from the injection, but the site is expected to be inflamed and sore for about 48 hours during which time pain medication and ice can be used as needed. Typically, by the fifth day after an injection, the patient experiences some significant relief from the original condition and begins physical therapy. Patients can return to work and other normal activities immediately after treatment, but should refrain from heavy lifting and strenuous activity for a few days. The doctor will monitor the patient to determine if and when another injection is necessary. WHAT ARE THE ADVANTAGES OF THIS PROCEDURE? For many patients, PRP injections offer significant relief from pain and other symptoms, and may eliminate the need for surgery or long-term medication. This treatment also speeds up the healing process, allowing patients to return to their normal activities more quickly than other nonsurgical treatments. Because the injected blood comes from the patient, there is no risk of cross-reactivity, immune reaction or disease transmission. Unlike corticosteroid injections, PRP injections actually facilitate healing, and have no issues with repeated Treatment. ARE PLATELET-RICH INJECTIONS SAFE? There is always a risk of infection or clotting with any type of injection, but such complications are extremely rare.

  Link: Platelet Rich Plasma Therapy

• Clinical Laboratories

  Although diagnosis of rheumatic and autoimmune diseases are dependent on appropriate history and thorough physical examination, laboratory investigations may be useful in confirming or ruling out rheumatic disease after a clinical diagnosis is considered. Once a rheumatic disease has been diagnosed, certain laboratory tests can help in assessing prognosis or determining the extent of the disease. Laboratory tests may also help the physician monitor certain rheumatic diseases, guide treatment or assess potential drug toxicity. Therefore, we offer our patients a full service on-site clinical laboratory to provide an enhanced and more convenient health care experience. We perform laboratory testing which aids our medical staff in the diagnosis or detection of diseases and measures the patient’s progress or recovery. Laboratory testing allows our medical staff and our patients to make better and more informed healthcare decisions.

  Link: Clinical Laboratories

• 

  CoolSculpting®

  It used to be that liposuction was the only type of body contouring procedure that was available to patients. However, times have luckily changed and there’s a new non-invasive, FDA approved procedure that can help get rid of stubborn, unwanted fat: CoolSculpting® HOW DOES COOLSCULPTING® WORK? CoolSculpting® technology works by freezing targeted fat cells and killing them. Once the fat cells have been frozen, your body will naturally eliminate them over the process of several months; leaving you with a slimmer looking physique. AM I A CANDIDATE FOR COOLSCULPTING®? Typically, good candidates for CoolSculpting® are of a healthy weight but just have a few extra pounds of fat that they want to get rid of. Additionally, patients who are good candidates for CoolSculpting® also don’t smoke, aren’t pregnant or planning on becoming pregnant, and are generally healthy. During your initial consultation, your physician will be able to determine whether or not CoolSculpting® is right for you. WHAT DOES A COOLSCULPTING® TREATMENT FEEL LIKE? Some patients experience a slight amount of pain or discomfort during the CoolSculpting® procedure itself while other patients don’t. For the most part, patients experience a strong cooling sensation that’s followed by a vacuum feeling. WHAT SHOULD I DO TO PREPARE FOR TREATMENT? The good news about CoolSculpting® is that there really isn’t much you have to do to prepare for treatment. On average, we encourage patients to quit smoking several weeks before treatment and to not take any non-steroidal anti-inflammatory drugs like ibuprofen for at least 24 hours before the procedure. WHAT ARE THE BENEFITS OF COOLSCULPTING®? The biggest benefit of CoolSculpting® is that it gives patients real results every time. And, because CoolSculpting® is a non-invasive procedure you won’t have to worry about any sort of surgery or recovery time. Additionally, because CoolSculpting destroys the fat in the body, it permanently gets rid of it.

  Link: CoolSculpting®

• Nutrition

  Proper diet is essential to maintaining good health. Keeping the body well-nourished and at a healthy weight has been proven to improve mood, quality of life and longevity. It may also go a long way in preventing or controlling many serious illnesses. Obesity, which has now reached epidemic proportions in the United States, and an enemy of good health, can be kept at bay through proper nutrition along with a program of healthy exercise. BENEFITS OF GOOD NUTRITION Not only do people feel more energetic and happier when they eat well, they also keep their bodies in the best possible condition. The benefits of good nutrition include developing and maintaining physical strength as well as preventing or controlling disease processes. Research has shown that the following disorders may be avoided, controlled, or mitigated by life styles that include well-balanced nutrition: Apnea Arthritis Asthma Certain cancers Gout Heart disease Hypertension Liver and gall bladder disease Osteoporosis Type 2 diabetes While there are complex causes for diseases to occur, some hereditary or unknown, proper nutrition can make a noticeable difference in keeping individuals healthy. A HEALTHY DIET Generally speaking, a healthy diet is a varied one, containing the balanced nutrition needed for cell growth, cell regeneration and the maintenance of healthy organs and tissues. It includes an appropriate balance of protein, fiber, carbohydrates and unsaturated fats in reasonable portions. A good diet is one that: Is rich in fruits, vegetables, whole grains and fat-free or low-fat milk products Includes protein sources such as lean meats, poultry, fish, beans, eggs, and nuts Is low in saturated fats, cholesterol, sodium and added sugars Contains a balance of appropriate vitamins and minerals Calorie intake should be determined by age, activity level and weight goal. While our culture tends to focus on avoiding obesity, being underweight or malnourished is also a serious and often life-threatening problem. In some cases, depending on age and physical condition, certain individuals may require vitamin or mineral supplements in order to maintain proper nutrition and an appropriate weight. Some patients, particularly some infants and geriatric patients, who are unable to ingest sufficient caloric intake in their diet, may require nutritional supplements to maintain a healthy weight. AVOIDING OBESITY Obesity, which affects approximately a third of all adults and a fifth of all children in the United States, is avoidable with proper diet and nutrition and a program of regular exercise. Through refraining from overeating and from ingesting foods high in calories and low in nutritional values, individuals can improve their health immeasurably. A regimen of physical exercise is also a very important part of a program designed to avoid obesity. NUTRITIONAL COUNSELING Since avoiding obesity requires making wise food choices, the more informed individuals are about what they eat, the better. Reading labels, eating fresh foods whenever possible and keeping informed about nutritional research — may all contribute to leading a healthier, and often a longer, life. Nutritional counseling is invaluable in pursuing this goal. Since more and more children have become obese, it is extremely important that nutritional counseling begin at an early age. Nutritional counseling services include initially taking a medical, and sometimes psychological, history and establishing a customized dietary plan for each individual patient. A specific diet takes into account each patient’s weight goals, personal food preferences, overall health and particular medical conditions. Anyone can benefit from nutritional counseling, especially patients with food allergies or eating disorders. Ongoing nutritional counseling allows for evolving dietary guidelines.

  Link: Nutrition