Providing Expert Care for Rheumatoid Arthritis

When you suspect a person may have an autoimmune disease that involves connective tissue, rheumatologists at Lehigh Valley Health Network (LVHN) are ready to help confirm the diagnosis and start appropriate therapies to slow and even halt disease progression. “We have the training and expertise to evaluate patients and get them on the correct treatment early on in their disease course. Early treatment typically leads to better long-term outcomes for our patients,” says rheumatologist Brian DelVecchio, DO, with LVPG Rheumatology. “We look at a patient’s history, physical exam, laboratory results and imaging to figure out what type of rheumatologic condition they have. Then, we get that patient treated correctly. It is also important in the treatment paradigm to match the intensity of the treatment to the severity of the disease.”

For rheumatoid arthritis (RA) in particular, the mechanism for disease activity is well established, as are methotrexate and steroids, the standard first-line treatments. However, the correct diagnosis of early stage RA often requires specialized testing. “It can even mean ruling out infectious diseases like Lyme in the Lehigh Valley’s more rustic areas,” says rheumatologist Nina Bhambhani, MD, with LVPG Rheumatology.

RA diagnostic capabilities at LVHN include musculoskeletal ultrasound, a relatively new avenue that requires the certification carried by Kourtney Rudzinski, DO, rheumatologist with LVPG Rheumatology.

“Ultrasound really helps when RA is suspected but symptoms are still mild and blood-test negative,” she says. “We can look for signs of joint inflammation that can’t be diagnosed on physical examination alone. This is incredibly important because the sooner we can get an individual treated, the better their course with the disease will be.”

For RA that has progressed, the goal of testing is to determine precisely which cytokines are playing the dominant role in a deranged immune system, Dr. Bhambhani says.

“It’s identifying excess cytokine production at a cellular level and blocking whichever molecule is most prevalent, which is very exciting,” she says. “We can be more efficacious, directly targeting the pathology that’s responsible without having to block an entire immune pathway.”

LVHN rheumatologists also go beyond the arthritic disease itself when fine-tuning RA medications to help prevent adverse effects in the presence of preexisting conditions. “It means taking other organ systems into account. It also means being able to safely change a medication strategy when a patient’s needs change,” Dr. DelVecchio explains.

LVHN occupational therapists also can be instrumental in mitigating pain when medications are starting to take effect. “They are able to provide deep relief with heat and ultrasound, which move more blood to the injured area,” Dr. Bhambhani says.