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What is conventional or traditional rheumatology?
Conventional rheumatology describes the medical care that is most common and that we are most familiar with in the US. In conventional rheumatology, the focus is on taking history and performing an exam, obtaining appropriate labs and imaging, making a disease diagnosis, and treating a diagnosis with prescription medications. Diagnosis and management are focused on the disease.
What treatments and medications are common in conventional rheumatology?
After taking a history and exam; labs, x-rays, ultrasound, and/or MRI may be ordered to assist in making the diagnosis. Treatments including medications in different forms including oral, injections and infusions are typically prescribed.
This includes medications that treat the cause of the inflammation, such as DMARDs and biologics. Corticosteroids, such as prednisone, and NSAIDs, such as aspirin and ibuprofen, treat flares of inflammation. Joint injections and physical therapy are additional treatments used frequently to manage rheumatologic disease.
What does the typical patient experience look like in traditional rheumatology, including diagnosis time, wait times, and referrals to other specialists?
There is often a long wait, several months in some cases, for a visit with a rheumatology specialist. Access to rheumatologists can be limited due to high demand and lack of enough specialists. This adds to the all-too-common delay in a diagnosis, which can be several months to years. Sometimes, a referral will be required from a person’s PCP to see a rheumatologist, depending on the insurance plan or practice.
What is integrative rheumatology?
Integrative Rheumatology is a combination of conventional rheumatology care, with the addition of holistic or complimentary treatments or care plans, making this an integrative approach to treating patients. The patient’s symptoms will be evaluated, diagnosed and managed from a whole body approach.
Rheumatologic diseases are most often systemic diseases that are affected by diet and lifestyle. Addressing diet, exercise, sleep, stress and mental health are some of the paths to assisting in achieving remission from disease, which cannot always be attained with medication alone. Integrative Rheumatology focuses on these lifestyle pillars, making changes in nutrition, sleep patterns, stress management, physical activity and mental health to improve a patient’s overall wellness. A team approach with experts in several of these areas is used in many cases. Improving these underlying areas of health will contribute to improving the disease.
Integrative health aims for well-coordinated care among different providers and institutions by bringing conventional and complementary approaches together to care for the whole person2.
How is integrative different from conventional? Key differences / similarities?
Starting with similarities, both conventional and integrative rheumatology will include taking a patient’s history and performing a physical exam (which in a virtual setting, means showing areas of swelling to the camera, or taking a photo and sending it in a secure way to your provider). Blood tests and imaging may be ordered to assist further in making a diagnosis. Medications would be the first line of treatment in conventional rheumatology, while addressing lifestyle changes would be a main focus in integrative rheumatology, with medication also being prescribed when needed.
The first difference between conventional and integrative rheumatology is in asking about your medical and family history. The history taken by an integrative rheumatologist will include diet, sleep, exercise, stress and other lifestyle aspects. The ongoing management in integrative rheumatology involves management of all these areas to bring disease under control, from a whole body approach.
What tools/treatments are common in integrative rheum?
Nutrition is a major focus and usually includes introducing an anti-inflammatory diet, often with a visit to a registered dietician recommended to guide the transition to a new diet. At Rheumission, our registered dietitian has specialized training to work with autoimmune patients. We also ensure that your food journey is taken at the pace that works for your lifestyle, which may mean you go through the anti-inflammatory diet more slowly or more quickly than others.
We have learned there is a significant connection between the gut, microbiome and inflammation in our bodies. Supplements are utilized for most patients, along with recommendations for physical activity, stress management, improving sleep and mind body medicine tools to manage symptoms of the disease. Acupuncture is another therapy often recommended.
What does the typical patient experience look like in integrative rheumatology?
The history taken will be a little different as noted above. Initially, treatment will focus on nutrition, moving towards an anti-inflammatory diet, as described above. Supplements are recommended, as well as regular physical activity that is gentle and does not stress your joints and muscles.
Stress management and mind body tools such as meditation, breath work and relaxation techniques are used to decrease the underlying inflammatory state in the body.
At Rheumission, we are fortunate to have a team of providers with expertise in all of these treatments and lifestyle changes to work with and help our patients. Your team will include lifestyle medicine providers, a registered dietician, and an autoimmune psychologist to support our patients.
What does training for integrative rheumatology include?
Training is usually additional training after completing the traditional education and residency as a physician, PA or NP. There are Integrative Medicine fellowships available at several medical schools in the country. The integrative providers at Rheumission were all trained at the Andrew Weil Center for Integrative Medicine at the University of Arizona.
As a provider, what made you decide to work in integrative rather than conventional?
An integrative approach is how I have tried best to live my own life and manage illness with positive results. I strongly believe there is so much we can do to prevent and manage disease with improvement in lifestyle modalities. It is very rewarding to work with patients who are actively involved in their disease management and wellness.
What benefits do you think integrative rheumatology brings patients?
Because rheumatologic diseases are systemic diseases significantly impacted by one’s lifestyle, including stress, nutrition, and sleep, improving these channels can have a significant impact on improving disease and achieving remission. Often, medication alone is not enough to achieve improvements when there is continued underlying inflammation triggered by poor diet, inadequate sleep or significant stress. Addressing the patient’s disease from a whole body perspective is very effective.
About the Author
Jill Ryan is a seasoned Rheumatology Physician Assistant with over 30 years of experience and a strong commitment to patient care. She worked at Dartmouth Health System as a Rheumatology Physician Assistant for 24 years, and prior to that role, as an Internal Medicine Physician Assistant for 8 years. Jill is deeply passionate about caring for patients and guiding them on their wellness journeys. With training in integrative medicine, she focuses on holistic approaches that empower individuals to manage autoimmune diseases effectively, believing in the importance of patient education and developing personalized care plans that promote overall health and well-being.
Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.
References
1. Integrative Rheumatology by Randy Horowitz, MD, PhD, Daniel Muller, MD, PhD. 2011.
2. NIH: National Center for Complementary and Integrative Health. Complementary, alternative, or integrative health: What’s in a name? 2022 Oct.