Managing the care of patients with rheumatic conditions can be complex, and coordinating that care can be a challenge for patients and families. The Ohio State University Wexner Medical Center’s rheumatology specialists work closely with other specialists, and they have now introduced two new clinics related to rheumatic conditions—for uveitis and inflammatory bowel disease (IBD).
Inflammatory bowel disease: Biologics may be an option
Patients with IBD often have other inflammation-related conditions and symptoms, including joint pain. Determining whether joint pain is related to IBD or some other condition, such as osteoarthritis or fibromyalgia, often requires referral to another specialist. That’s no longer the case at the Ohio State Wexner Medical Center, as rheumatologist Ali Ajam, MD, is joining forces with the Ohio State Wexner Medical Center’s IBD Center medical director and gastroenterologist Anita Afzali, MD, and her team to provide evaluation and care for patients who may be experiencing IBD-related joint pain.
Dr. Ajam’s experience brings a new level of care for IBD patients who may have related joint pain.
“There’s no specific blood test to determine whether a patient has enteropathic arthritis, although bloodwork can show indicators, inflammation markers and so forth,” Dr. Ajam says. “So it’s primarily a clinical diagnosis, and it’s determined by the kind of symptoms the patient has, and also the signs that you see on exam. Sausage-like swelling of fingers and toes, for instance, is one of the things we see in patients with Crohn’s or ulcerative colitis. Sacroiliac joint pain can also be a sign, especially if that pain worsens when the person is sitting for long periods of time. We also do some bloodwork, and imaging certainly has a significant role to play.”
If joint pain is related to IBD, biologic agents are among the treatment options. Physical therapy, and in rare cases, joint surgery may be needed to improve range of motion and reduce symptoms. Nutrition and diet guidance may also be helpful.
“We have several pretty specific medications that are designed to treat enteropathic arthritis,” Dr. Ajam says. “We’ve got new biologic drugs, disease-modifying drugs, oral, intravenous, injectables, all kinds of options that basically are designed to reduce inflammation and halt or slow the progress of the arthritic condition. With autoimmune conditions, having an overall multidisciplinary approach is so important. That’s why it’s a multidisciplinary clinic where we have a GI specialist, nutrition specialist and pharmacist. All these things make a big difference.”
Uveitis: When steroids are not enough
Uveitis is often caused by an autoimmune syndrome or disorder and may be concurrent with IBD and joint pain. To better serve patients with uveitis associated with an autoimmune disorder, the Ohio State Wexner Medical Center has launched a new multi-disciplinary clinic.
Uveitis and its characteristic redness, pain, sensitivity to light and blurred vision need prompt diagnosis and treatment to avoid complications that can include macular edema, retinal scarring or detachment, optic nerve damage and even permanent blindness.
“Any uveitis should be promptly evaluated to rule out systemic involvement or to treat it,” Dr. Kenol stresses. “These patients may also have other signs of inflammation, such as a rash, psoriasis, joint inflammation or diarrhea.”
Steroids and eye drops are often prescribed for uveitis, but in some cases, they aren’t enough. The clinic is taking referrals from rheumatologists and ophthalmologists, mainly working with patients for whom steroids aren’t working well or are not an option.
“Other options, including immunotherapy, can help reduce the need for steroids or help if steroids aren’t working well,” Dr. Kenol says. “The immunotherapy can be pills, self-injection under the skin or intravenous infusions—there are many different forms. And the immunotherapy can often work for other manifestations of the autoimmune disorder in addition to nonpharmacologic ways to decrease inflammation, such as eating a healthy diet, regular exercise and avoiding smoking.”
Care during COVID-19
Both the uveitis clinic and the IBD clinic are using telehealth to help provide follow-up care during COVID-19. Both clinics require an in-person evaluation and may need to see patients in person to assess the patients’ condition or progress; however, some follow-up visits can be provided through video.
For in-person visits, masks and all appropriate precautions are taken to ensure the health and safety of patients and staff.