Living with Sjögren’s Syndrome: A Guide to Diagnosis, Treatment, and Long-Term Management

By:

Dr. Micah Yu, MD, MHA, MS

If you are reading this, you know that Sjögren’s Syndrome is an autoimmune condition where your immune system attacks the glands that produce moisture: your tear and salivary glands. This condition can cause dry eyes and mouth, but it can also affect other parts of your body. As with all other rheumatology and autoimmune conditions, it can be difficult to diagnose if you don’t have the right provider. The information below is meant to guide you with more information to have a comprehensive conversation with your doctor, or find a doctor who can help diagnose and treat your condition and overall health.

What Are Early Symptoms That Could Be Sjogrens?

Catching Sjögren’s early can make a big difference in managing it effectively. If you notice these symptoms, it’s worth discussing them with your doctor to get a proper evaluation³. Here are some early signs to look out for:

Persistent dry eyes and mouth
Swelling of the salivary glands
Joint pain or swelling
Skin rashes or dry skin
Persistent cough
Vaginal dryness in women

Does Sjögren’s Syndrome Progress Over Time?

Yes, Sjögren’s can progress if not treated. It typically presents in mild, moderate, or severe forms. Here’s what each stage looks like:

Mild Sjögren’s: Symptoms like dry eyes and mouth are present, but manageable with lifestyle changes and over-the-counter products.
Moderate Sjögren’s: Symptoms are more persistent and may require prescription medications. There might be joint pain and fatigue.
Severe Sjögren’s: The condition affects multiple organs and requires comprehensive treatment. Patients might experience significant dryness, severe fatigue, joint pain, and complications such as in the lungs or kidneys¹.

How is Sjögren’s Syndrome Diagnosed?

The journey to diagnosing Sjögren’s Syndrome involves several steps. Your doctor will look at your symptoms, medical history, and perform some tests. Here’s what you can expect:

Physical Examination: Your doctor will check your eyes and mouth for dryness.
Symptom Review: You’ll discuss how dry your eyes, mouth, nose, throat, and skin feel.
Blood Tests: These tests look for specific antibodies like anti-SSA (Ro) and anti-SSB (La) that indicate Sjögren’s².
Saliva and Tear Production Tests: Techniques like the Schirmer’s test measure how much tears your eyes produce.
Imaging Studies: Tests like ultrasounds of your salivary glands show their structure and function².

Even if you don’t test positive for these antibodies, you can still have Sjögren’s. It’s all about the bigger picture. So if your lab results come back negative, but you still have all the symptoms of Sjögren’s, this is called Seronegative Sjögren’s. Your diagnosis will depend on your symptoms, physical exams, and other tests. It’s important to keep working with your doctor, or find a doctor who can provide a second opinion, to get a full understanding of your health³.

Does Sjögren’s Look Similar to Other Conditions?

Several conditions can mimic Sjögren’s, making it tricky to diagnose. Here are a few:

Systemic Lupus Erythematosus (SLE): Causes joint pain, fatigue, and dry eyes/mouth.
Rheumatoid Arthritis (RA): Affects joints and can cause dryness.
Multiple Sclerosis (MS): Causes fatigue and muscle weakness.
Thyroid Disorders: Conditions like hypothyroidism can cause similar symptoms.
Chronic Fatigue Syndrome (CFS): Features persistent fatigue and joint/muscle pain.
Medication-induced Dryness: Some medications can cause dry eyes and mouth.

Getting the right diagnosis means you can start the right treatment and feel better sooner¹.

Now That I’ve Been Diagnosed, What Are My Treatment Options? Finding What Works for You.

Managing Sjögren’s Syndrome involves treating the symptoms and the underlying autoimmune response. Here’s a look at some treatment options:

Artificial Tears and Eye Drops: These help with dry eyes².
Saliva Substitutes: These can ease dry mouth symptoms.
NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen help with inflammation and pain.
Prescription Medications: Can be used for joint pain and fatigue¹, and saliva production³.

Topical Corticosteroids: Used for localized inflammation.

Your doctor will help you find the right medications and dosages. Keep a symptom log to see how these treatments impact your symptom, and whether they create new symptoms or side effects.

What Lifestyle Changes Can Be Part of My Treatment Plan?

Making a few changes to your daily routine can make a big difference. Here’s how:

Stay Hydrated: Drink plenty of water to combat dryness.
Use Humidifiers: They add moisture to the air and help with dryness in your eyes, mouth, and throat.
Good Oral Hygiene: Use a soft toothbrush and fluoride toothpaste. Regular dental check-ups are crucial.
Eye Care: Use artificial tears and protect your eyes from irritants².
Protect Your Joints: Gentle exercises can improve joint mobility. Avoid activities that stress your joints.
Manage Stress: Stress can worsen symptoms. Try relaxation techniques like deep breathing or meditation.
Balanced Diet: Eat foods rich in nutrients and omega-3 fatty acids. Avoid spicy or acidic foods that can irritate your mouth.

Which Supplements Will Help the Most?

While there’s no cure for Sjögren’s, certain supplements can help. Always talk to your doctor before starting any new supplement. Here are a few that might help:

Omega-3 Fatty Acids: These have anti-inflammatory properties⁴.
Vitamin D: Supports bone health and immune function².
B-Complex Vitamins: Helps with nerve function and energy levels.
Vitamin C: An antioxidant that boosts your immune system.
Probiotics: Promote a healthy gut microbiome.
Coenzyme Q10: Helps with cell energy production.

What Is My Potential Impact to My Daily Life?

Living with Sjögren’s can significantly affect daily activities, but every day is different. With the right treatment, you can have many more good days than hard ones. Here are some common challenges and tips to manage them:

Fatigue Management: Plan your day to include rest periods and prioritize activities to conserve energy.
Hydration on the Go: Carry a water bottle and use portable humidifiers or misters.
Oral Care: Keep sugar-free candies or lozenges handy to stimulate saliva production.
Joint Protection: Use ergonomic tools and avoid repetitive motions that strain your joints.
Skin Care: Use moisturizers regularly to combat dry skin and prevent irritation.

Understanding the ways your body responds to your condition, and how to best manage each day can truly help improve your quality of life³.

By understanding Sjögren’s Syndrome and making informed decisions about diagnosis, treatment, and lifestyle changes, you can manage your symptoms better, and improve your life. Rheumission is here to help, whether to answer questions you may have, or to see you for an initial diagnosis or second opinion.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

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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. Shiboski, C. H., Shiboski, S. C., & Criswell, L. A. (2017). American College of Rheumatology classification criteria for Sjögren’s syndrome: A data-driven, expert consensus approach in the SICCA cohort. Arthritis Care & Research, 69(6), 948-956. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349440/

2. Ramos-Casals, M., Brito-Zerón, P., & Kostov, B. (2020). EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Annals of the Rheumatic Diseases, 79(1), 3-18. https://pubmed.ncbi.nlm.nih.gov/31672775/

3. Vivino, F. B., Bunya, V. Y., & Massaro-Giordano, M. (2019). Sjögren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clinical Immunology, 203, 81-92. https://pubmed.ncbi.nlm.nih.gov/31022578/

4. Baer, A. N., & Walitt, B. (2017). Sjögren’s syndrome and other causes of sicca in older adults. Clinics in Geriatric Medicine, 33(1), 87-103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125547/

Integrative Medicine: 8 Reasons A Whole Person Approach to Health Can Help You Get Back to Being You

Integrative medicine is a whole person approach that combines conventional treatments with complementary therapies.

As someone who's faced the challenges of chronic illness and autoimmune disease, I understand how crucial it is to have a healthcare approach that sees you as a whole person, not just a set of symptoms. But what is integrative medicine? How is it different from other types of medicine, and how can it help you on your health journey? I'll try to explain this with 8 factors that set it apart, which are all so important for holistic treatment to help you find a new normal on your autoimmune journey.

What is Integrative Medicine?

Integrative medicine is a holistic approach that combines conventional treatments with complementary therapies. It focuses on treating the whole person – mind, body, and spirit. Unlike conventional medicine, which often zeroes in on specific symptoms and diseases, integrative medicine looks at all aspects of your health and well-being. This approach has helped me immensely, both as a patient and a provider to people with rheumatology conditions.

Integrative Medicine vs. Conventional and Functional Medicine

You might be wondering how integrative medicine differs from conventional and functional medicine. Conventional medicine is what most of us are familiar with – doctors diagnosing and treating diseases primarily with pharmaceuticals and surgery. Functional medicine, on the other hand, aims to identify and address the root causes of diseases, often through personalized nutrition and extensive food and other testing. Integrative medicine encompasses the best of both worlds, combining conventional treatments with holistic practices like nutrition, exercise, and mindfulness^1,2.

Studies have shown that patients often report higher satisfaction with integrative medicine because it provides a more personalized and compassionate approach to care^1,2. Patients feel more connected to their healthcare team, and this relationship can lead to better health outcomes.

So with that background, here are the top 8 reasons Integrative Medicine is different and better for your treatment, slowing condition progression, and overall improvement of your quality of life.

#1: The Power of Food and Nourishment

One of the pillars of integrative medicine is nutrition. You’ve probably heard the saying, “food is fuel,” and it’s true! Research has shown that phytonutrients found in fruits, vegetables, and other plant-based foods can have anti-inflammatory effects on the body. Changing my diet has been a game-changer for me and my patients. Unfortunately, conventional medicine often overlooks nutrition, but integrative practitioners are working to change that².

#2: Movement and Exercise

Another key component is exercise and gentle movement. Whether it’s strengthening exercises, stretches, yoga, or simply walking, physical activity is essential for improving health. Exercise not only benefits the body but also the mind, helping to reduce stress and improve mood¹.

#3: Focusing on the Mind

Our mental health is just as important as our physical health. Integrative medicine uses techniques like guided imagery, hypnotherapy, and mindfulness to help manage both physical and mental health challenges. These therapies can be incredibly effective for reducing stress and improving overall well-being^1,2.

#4: Alternative Treatments

Integrative medicine also includes alternative treatments such as acupuncture, vagus nerve treatment, and therapeutic massages. While these treatments might not work for everyone, they can be beneficial when used alongside conventional therapies.

#5: Environmental Medicine

Integrative medicine considers the impact of environmental factors on health. Pollution, toxins in products, and other environmental influences can contribute to chronic inflammation and other health issues. By addressing these factors, integrative medicine offers a more comprehensive approach to treatment².

#6: The Importance of Sleep

Sleep is a critical component of overall health, yet it's often neglected. Integrative medicine emphasizes the importance of good sleep hygiene and aims to identify and treat sleep disorders that may be contributing to chronic health issues. Techniques such as improving sleep environments, establishing regular sleep routines, and using relaxation therapies can make a significant difference in a patient's sleep quality².

#7: Social Connections and Support Networks

Strong social connections and support networks play a vital role in maintaining health and wellness. Integrative medicine encourages patients to foster relationships and build communities that provide emotional support. This can include group therapy sessions, community activities, or simply maintaining close contact with family and friends. The sense of belonging and support can greatly enhance mental and emotional health^1,2.

#8: Personalized Medicine

Integrative medicine is all about personalized care. Each patient is unique, and their treatment plans should reflect that. Integrative medicine providers take the time to understand the individual's health history, lifestyle, and personal goals. This personalized approach ensures that treatments are tailored to the specific needs of each patient, leading to more effective and meaningful health results that you can see and feel in your daily life².

A New Approach to Healthcare

Integrative medicine is an open-minded and beneficial way to approach healthcare. Despite some misconceptions, it doesn’t reject conventional medicine, but enhances it with additional tools and strategies. This dynamic approach is the future of healthcare, especially for those of us living with chronic illness¹.

If this resonates with you, consider seeking out a doctor who practices integrative medicine. Our doors are always open at Rheumission, and many other practices share our whole person approach to health.

Take control of your health journey and explore the benefits of integrative medicine today. You deserve a healthcare approach that sees and treats you as a whole person. Stay healthy and strong!

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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About the Author

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References

1. Mastorci, F. (2023). Toward Patient Care: Integrative and Complementary Approaches. https://link.springer.com/chapter/10.1007/978-3-031-23852-9_11

2. "The possibilities and challenges of integrative medicine implementation in clinical psychology: a qualitative study in Indonesia." (2020). BMC Complementary Medicine and Therapies, 20(1), 1-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362562/

5 RA Things to Know + Talk With Your Doctor - For Life with Rheumatoid Arthritis at Any Condition Stage

A deeper look into some important factors about RA that will help you work with your rheumatologist to live a fuller, healthier life.

As we all know only too well, Rheumatoid Arthritis (RA) is a long-term autoimmune condition marked by painful, swollen joints, progressing over time if not controlled. Although its exact cause is unknown, a mix of genetics and environmental factors is believed to trigger its initial onset¹.

Rheumatoid Arthritis is much more complex than joint pain and swelling, which you probably know if you have lived with the condition for any length of time. It's so important to understand how an autoimmune condition affects your whole body so that you can make each day the best it can be, for you and your family/friends.

Understanding diagnosis types, symptoms that appear unrelated but are actually all tied back to your RA, gut health's critical tie-in, your mouth's overall health information and the hallmark warning against smoking are all important factors to know about your condition. We hope that this post will arm you with a wider understanding of your RA health, and help you work with your rheumatologist and wider care team to live a fuller, healthier life.

#1: Antibodies Influence Different RA Types

Specific antibodies like anti-citrullinated protein antibodies and Rheumatoid Factor in the blood can help identify RA types and may be detectable years before symptoms appear².When these antibodies are present, it’s termed seropositive RA. When they are not present, your condition is defined as seronegative RA. Regardless of the type, you still have Rheumatoid Arthritis, and treatment approaches remain similar – don’t let any providers tell you differently. When these antibodies are present, it’s termed seropositive RA. When they are not present, your condition is defined as seronegative RA. Regardless of the type, you still have Rheumatoid Arthritis, and treatment approaches remain similar – don’t let any providers tell you differently.
What does this mean for you? Understanding whether you have seropositive or seronegative RA can help tailor your treatment plan. If you test positive for these antibodies, you might receive earlier and more aggressive treatments to manage symptoms and prevent joint damage. Even if you are seronegative, the same treatment strategies apply, emphasizing the importance of monitoring and managing the disease and finding a rheumatologist who understands the role of antibodies -- and that they don't determine a diagnosis.

#2: Rheumatoid Arthritis' Impact Beyond Joints

While RA primarily affects joints, it can also involve other organs and systems (as with any autoimmune condition). Rheumatoid Arthritis is associated with an increased risk of conditions like depression, obesity, brain fog, heart disease, and eye issues such as scleritis, which causes redness, pain, blurry vision, and light sensitivity^3,4. Additionally, people living with RA often experience greater fatigue. We feel the impact in daily life and activities from chronic pain and physical ability differences that didn’t occur before¹⁰.
What does this mean for you? Being aware of the systemic nature of RA can help you and your healthcare provider monitor and address symptoms beyond joint pain. Regular check-ups for cardiovascular health, mental well-being, and eye health are crucial. This whole body approach ensures comprehensive care, improving your overall quality of life.

#3: Diet’s Role in Rheumatoid Arthritis Management

Eating a diet rich in fish, fruits, and vegetables can lower the risk of developing RA. Essential nutrients, particularly beta-cryptoxanthin and vitamin D (often low in RA patients), play a crucial role in managing and even preventing the disease^5,6,7. Research also suggests that incorporating anti-inflammatory foods like turmeric and ginger can help reduce RA symptoms¹¹.
What does this mean for you? Adopting an anti-inflammatory diet can be a powerful tool in managing Rheumatoid Arthritis. Adding even small amounts of foods that are rich in omega-3 fatty acids, antioxidants, and vitamins can help reduce inflammation and support joint health. Consider consulting with a registered dietitian who is familiar with autoimmune conditions. They can help create a diet plan that supports your treatment regimen can help improve your overall health as well as your RA-specific management.

#4: Oral Health’s Connection to Rheumatoid Arthritis

A healthy mouth is vital in preventing RA. The oral biome, maintained by saliva, can be disrupted by harmful bacteria, potentially. Proper oral hygiene helps prevent this autoimmune response⁸.
What does this mean for you? Maintaining good oral hygiene can reduce the risk of developing or progressing your Rheumatoid Arthritis. Regular dental check-ups, proper brushing and flossing, and avoiding habits that harm oral health are essential. This simple but effective measure can support your overall health and potentially reduce RA symptoms.

#5: Smoking Elevates Rheumatoid Arthritis Risk

Tied to #4 above, smoking significantly impacts RA risk by altering the oral microbiome, increasing oxidative stress, and introducing harmful particulates.
Both smoking/vaping, and second-hand smoke can worsen RA^8,9. Quitting smoking is essential for reducing Rheumatoid Arthritis risk, as well as limiting your exposure to smoke vapors and fumes. We know it's easy to say "quit smoking" -- but any reduction in nicotine consumption is a positive. Finding the right smoking cessation program for you, being gentle with yourself, and finding ways to replace the reasons you are smoking/vaping are all good things to bring together to help your health and well-being.
What does this mean for you? If you smoke or vape, quitting can significantly reduce your risk of developing RA or progressing its symptoms. Avoiding second-hand smoke is also crucial. Seeking support through cessation programs or consulting with healthcare providers can provide the necessary tools and strategies to quit smoking and improve your overall health. While it may not seem that smoking should be connected to a systemic joint condition, the research proves the connection is there.

Understanding the deeper elements of RA, from the role of antibodies and diet to the importance of oral health and the impact of smoking, is vital in managing and preventing this chronic condition. Adopting a balanced lifestyle with a healthy diet, regular exercise, and good oral hygiene can go a long way in mitigating the risks associated with rheumatoid arthritis. We are always available to answer more questions, and help you create a treatment plan that covers all of the factors listed here.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

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References:

1. Chauhan K, Jandu JS, Goyal A, et al. Rheumatoid Arthritis. [Updated 2021 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. National Library of Medicine

2. Derksen, V., Huizinga, T., & van der Woude, D. (2017). The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Seminars in immunopathology, 39(4), 437–446. PubMed/NIH

3. CDC. (2020, July 27). Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. CDC.gov

4. Promelle, V., Goeb, V., & Gueudry, J. (2021). Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. Journal of clinical medicine, 10(10), 2118. PubMed/NIH

5. Skoczyńska, M., & Świerkot, J. (2018). The role of diet in rheumatoid arthritis. Reumatologia, 56(4), 259–267. National Library of Medicine

6. Vadell, A., Bärebring, L., Hulander, E., Gjertsson, I., Lindqvist, H. M., & Winkvist, A. (2020). Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. The American journal of clinical nutrition, 111(6), 1203–1213. PubMed/NIH

7. Sukharani, N., Dev, K., Rahul, F., Bai, P., Ali, A., Avinash, F., Kammawal, Y., Kumar, N., & Rizwan, A. (2021). Association Between Rheumatoid Arthritis and Serum Vitamin D Levels. Cureus, 13(9), e18255. National Library of Medicine

8. Nikitakis, N. G., Papaioannou, W., Sakkas, L. I., & Kousvelari, E. (2017). The autoimmunity-oral microbiome connection. Oral diseases, 23(7), 828–839. National Library of Medicine

9. Pizzino, G., Irrera, N., Cucinotta, M., Pallio, G., Mannino, F., Arcoraci, V., Squadrito, F., Altavilla, D., & Bitto, A. (2017). Oxidative Stress: Harms and Benefits for Human Health. Oxidative medicine and cellular longevity, 2017, 8416763. National Library of Medicine

10. Smolen, J. S., Aletaha, D., & McInnes, I. B. (2016). Rheumatoid arthritis. The Lancet, 388(10055), 2023-2038. The Lancet

11. Bhatt, D. L., & Topol, E. J. (2002). Anti-inflammatory therapy in rheumatoid arthritis: The potential role of natural products, vitamins, and trace elements. Cardiovascular Therapeutics, 20(3), 201-209. PubMed/NIH

How Do Virtual Rheumatology Appointments Work & Are They as Good as In-Person?

We take a virtual-first approach to treating rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. See how this helps us better serve patients.

How does a virtual rheumatology care team work for you?

As you go through your patient journey, there’s one key element that becomes clear: finding the right, supportive rheumatologist and overall healthcare team is the most important part of life as a person with a chronic condition.

The right doctor and team help keep you on a successful path to sustained remission – feeling good, positive and hopeful each day about the symptoms that touch most aspects of your life and the treatment to heal them.

When you're looking for or considering a new rheumatology practice, it may feel like a given that an in-person appointment is mandatory. And I understand that, as an autoimmune rheumatology patient myself, first diagnosed 14 years ago.

However, through the years of my practice and as a patient, I see great benefits to a telehealth practice — if I felt I wasn't able to diagnose you, or treat your symptoms as well or better than an in-person appointment, I would not practice medicine this way.

Rheumission has adopted a virtual-first approach to treating rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We believe that our telehealth model improves accessibility, convenience, and better serves our patients overall. Below I’ll take you through the three reasons why.

Why is a virtual visit as good as an in-person visit?

A virtual rheumatology visit can be just as good as an in-person visit because, in both scenarios, the patient’s clinical history, labs, and imaging often inform the diagnosis.

Sometimes, swelling can be subtle and hard to visualize through a virtual exam. In these cases, the patient would be referred out for imaging. This is not dissimilar to in-person visits - rheumatologists often order imaging to fully visualize joint swelling before confirming a diagnosis.

An in-person visit does allow me to press on joints and do needle injections and aspirations. If injections are needed for virtual patients, you may be referred to local clinics who can perform the test and then send me the results that we can review together.

How can I ensure that my diagnosis will be the same as if I saw you in-person?

A rheumatology diagnosis relies most heavily on the patient’s clinical history, labs, and imaging. However, there are some cases where parts of the physical exam are unclear, and the patient’s history, labs, and imaging do not provide enough information. In these few cases, a referral to an in-person rheumatologist may be needed.

In all rheumatology visits, it’s important that I can focus on you, and listen closely to your history. Some in-person doctors barely examine patients or look at them during a visit.

Communication does not need to be rushed during a telehealth visit, and communication styles are often very individual to the provider. At Rheumission, our initial visits are one hour long, and follow-up visits run for 30 minutes. This is an uncommonly high amount of time for medical appointments, but we understand and value deeply listening to our patients and their history, before jumping into treatment decisions.

What are some benefits of virtual care?

Virtual care increases accessibility and decreases wait times before appointments. If there’s a case where you need an in-person exam, you can start and continue on with virtual appointments rather than waiting months for any sort of care.

As an autoimmune patient myself, I know that a lot of autoimmune patients struggle with brain fog and keeping track of their appointments. One benefit of virtual care is that it’s easier to jump into a visit or make up a visit after the fact. For example, say you forgot about your appointment and went to the beach. You remembered that you had an appointment once you got there, but you could still complete the exam outside of your home. Virtual visits can be completed anywhere at the convenience of the patient. If this were an in-person visit, it would be much more difficult to make up the visit if forgotten.

A common issue with our world’s shift towards more remote/virtual models is a general decrease in physical activity. In the case of virtual appointments, you lose the walk to and from the clinic.

This would be a loss for a conventional telehealth practice that does not include movement as a part of its treatment approach. However, here at Rheumission, we’ve adopted an integrative, lifestyle approach where we encourage patients to incorporate more movement into their routine as part of every treatment plan.

So what's the most important thing to know about telehealth rheumatology visits?

Remote rheumatology visits are comparable to in-person appointments, with increased availability, convenience, and unrushed time for deeper conversations about your health.

While remote models are still relatively new, we believe that the increased accessibility and coordination of care within a telehealth practice is the best way forward for rheumatology patients, which is why we set up Rheumission – so that we can give you the best care possible.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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About the Author

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What is Lifestyle Medicine and How Will It Work for Me and My Treatment?

In recent years, the fields of lifestyle medicine and integrative medicine have gained attention for their holistic approaches to health and wellness.

Living with an autoimmune condition can feel like navigating a complex maze of doctors appointments, various treatments and expensive medications.

Many people with autoimmune arthritis, which we treat, find themselves searching for relief from years of pain and suffering. We understand this at Rheumission, since our method was developed by autoimmune patient-doctors.

In recent years, the fields of lifestyle medicine, integrative medicine and functional medicine have gained attention for their holistic approaches to health and wellness.

Here at Rheumission, we aim to combine the best tools and levers from integrative, functional and conventional medicine to help our patients reach remission.

But what exactly is lifestyle medicine? It’s an important new field of medicine that is helpful to understand both how it differs from other fields of medicine, and how it fits into the broader picture of managing conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

What is lifestyle medicine and how will it help me?

The American College of Lifestyle Medicine defines lifestyle medicine as a “medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions.”

In other words, as lifestyle medicine certified clinicians, we take a holistic approach and treat our patients first with evidence-based and prescriptive lifestyle change.

We still use medications when needed, but our aim is to utilize the 6 pillars of lifestyle medicine to treat, prevent and even reverse disease:

Whole food plant-based nutrition
Physical activity
Stress management
Restorative sleep
Avoidance of risky substances
Positive social connections

Lifestyle medicine is about empowering you to take an active role in your health in a new way, by supporting you with the tools necessary to improve not only your health, but also your quality of life!

In lifestyle medicine, we often ask patients, “What is your why?” In other words, what gets you up in the mornings? What motivates you? Why do you want to improve your health?

From my experience working in primary care and lifestyle medicine, some examples of a patient’s “why” may be to see their grandchildren graduate from college, to travel to new and exciting places or to be there for their children as they grow up.

Usually it boils down to wanting more quality time with loved ones, traveling to see new places, or feeling fulfilled in one’s purpose in life. Once a patient connects with their deeper why, they are often more motivated to make the necessary changes for improved health and happiness.

How will you use lifestyle medicine to help me with my autoimmune arthritis?

The pillars of lifestyle medicine encompass various aspects of daily life that profoundly impact health outcomes:

Nutrition: Scientific evidence strongly supports the use of whole-food, plant-predominant food choices for preventing and treating chronic disease.
1. This diet is rich in fiber, antioxidants and essential nutrients found in minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds.
2. For people with autoimmune conditions, this is particularly important because a whole-food plant-based diet has been proven to be anti-inflammatory.
3. Aim for half of your plate to be green leafy vegetables or non starchy vegetables, a quarter of the plate be protein - ideally a plant protein like legumes - and a quarter of the plate be whole grains or starchy vegetables.

Physical Activity: Regular exercise is essential for maintaining joint mobility, muscle strength, and overall physical function.
1. Low-impact activities like walking, swimming, yoga, and tai chi can be particularly beneficial for individuals with autoimmune arthritis, helping to manage pain and stiffness while improving cardiovascular health.
2. Find a form of movement that brings you joy, and aim to do it on a regular basis.
Stress Management: Chronic stress can exacerbate inflammation and contribute to symptom flare-ups in rheumatic diseases.
1. Techniques such as mindfulness meditation, deep breathing exercises, prayer, positive self-talk, progressive muscle relaxation, and cognitive-behavioral therapy can help individuals better cope with stress and improve their overall well-being.
2. Find a mindfulness practice that you enjoy and aim to do it for at least 3 - 5 min per day.
Restorative Sleep: Adequate sleep is crucial for immune function, tissue repair, and overall health. Poor sleep quality or sleep disturbances are common in patients with autoimmune arthritis.
1. Lack of sleep triggers the sympathetic nervous system to release fight or flight neurotransmitters, impairs our gut microbiome and interferes with normal hormone balance and function.
2. All of these factors play a role in triggering an increase in pro-inflammatory particles which can worsen autoimmune symptoms and disease.
3. Establishing healthy sleep habits and addressing sleep disorders can significantly improve health outcomes and can reduce chronic pain.
4. Try to optimize your sleep environment and aim for 7 hours of sleep each night.
Positive Social Connections: Strong social connections and a supportive network of friends, family, and peers play a vital role in our physical, mental and emotional health.
1. Engaging in meaningful social activities, joining support groups, and fostering positive relationships can provide emotional support and enhance overall well-being.
2. Aim to have one positive and meaningful connection each week.
Avoidance of Risky Substances: Engaging in tobacco use and alcohol consumption have been linked to higher risks of chronic diseases and mortality.
1. Treating these habits typically requires multiple approaches and attempts over time.
2. Be patient with yourself and seek help from your clinicians and your support system.

How is lifestyle medicine different from my primary care doctor?

At Rheumission, our lifestyle medicine clinicians have a background in primary care with additional training in lifestyle medicine. This additional training includes an emphasis on the lifestyle interventions described above.

When you meet with our lifestyle medicine clinicians, they will focus on how the pillars of lifestyle medicine are affecting your chronic conditions, and will partner with you to make sustainable lifestyle changes.

We encourage our patients to continue to see their primary care physician as the Rheumission team – including your integrative rheumatologist, lifestyle medicine clinicians, and autoimmune registered dietitian – will be partnering, and coordinating with your primary care provider in some instances, for your care. You can think of your Rheumission team as an additional team-based specialty that you are seeing.

How does lifestyle medicine differ from integrative or functional medicine?

While lifestyle medicine, functional medicine and integrative medicine all share common goals of promoting health and wellness, each approach has its unique focus and methodologies.

Lifestyle medicine has its distinct emphasis on promoting healthy behaviors and lifestyle modifications to prevent and manage chronic diseases.

It recognizes that many chronic conditions, including autoimmune diseases, are influenced by lifestyle factors such as diet, physical activity, stress management, sleep quality, and social connections. Lifestyle medicine encourages individuals to adopt sustainable lifestyle changes that support their overall health and well-being.

Integrative medicine emphasizes the integration of conventional medical treatments with complementary and alternative therapies. It acknowledges the importance of addressing the physical, psychological, social, and spiritual aspects of health to achieve optimal well-being. In the context of autoimmune conditions, an integrative rheumatologist may combine conventional medications with interventions such as massage therapy, or mind-body practices, to manage symptoms and improve quality of life.

Functional medicine investigates the underlying root causes of disease by examining the interactions among genetic, environmental, and lifestyle factors. Practitioners of functional medicine take a systems-oriented approach, considering the interconnectedness of various bodily functions and how imbalances in one area can affect others. For individuals with autoimmune conditions, a functional medicine provider may focus on identifying triggers such as dietary factors, gut health issues, or environmental toxins that contribute to inflammation and symptom flare-ups.

At Rheumission, our two Medical Directors, Dr. Micah Yu, MD, and Dr. Melissa Mondala, MD, are both trained in the conventional medical model and in lifestyle medicine, integrative medicine and functional medicine.

What is lifestyle medicine's role in the Rheumission Way?

Our lifestyle medicine clinicians work closely with the integrative rheumatologist, registered dietitian and autoimmune psychologist. We have a strong, interdisciplinary care team that works together and with you, our patient, to provide holistic, personalized ongoing care with the goal of sustained remission.

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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Want to learn more about the integrative rheumatology pillar of Rheumission? Read our founding Integrative Rheumatology Director Dr. Micah Yu's post about how and why telehealth rheumatology appointments are just as good or better than in-person appointments for easier access and greater convenience, while offering an assessment of symptoms and treatment options that are the same as going in-person.

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About the Author

Christina Lascano, MPAS, DipACLM, PA-C, is a highly skilled, board-certified Physician Assistant with additional board certification in Lifestyle Medicine from the American College of Lifestyle Medicine. Christina graduated from the University of North Texas Health Science Center in 2017, earning a Masters of Physician Assistant Studies. She also holds a Bachelor of Science in Allied Health from Texas A&M University, which she completed in 2014. With over seven years of dedicated experience as a PA, Christina is committed to empowering her patients through personalized and prescriptive lifestyle interventions, striving to enhance their health and overall quality of life.

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How Rheumission Empowers Wellness Through Food

At Rheumission, we firmly believe in harnessing the transformative power of food to elevate your health and quality of life while living with chronic illness.

At Rheumission, we firmly believe in harnessing the transformative power of food to elevate your health and improve your quality of life while living with chronic illness. Our approach is characterized by deep empathy and a multidisciplinary team dedicated to enhancing your life. It's not just about treating symptoms; it's about thriving, using anti-inflammatory nutrition & lifestyle, integrative rheumatology and lifestyle medicine pillars as our guiding stars.

Understanding food as medicine

So, what do we mean by "food as medicine"? It's a concept that extends far beyond just eating to fill our bellies. Food plays a crucial role in providing essential nutrients, but it also acts as a powerful agent in disease prevention and management. Rich in nutrients, anti-inflammatory agents, antioxidants, and fiber, nutritionally dense, whole foods are instrumental in combating chronic inflammation, neutralizing harmful reactive oxygen species, regulating hormones, and fostering a diverse gut microbiome.

The benefits of adopting a diet rich in these elements are extensive. Anti-inflammatory dietary patterns not only help ward off weight challenges, but also improve autoimmune symptoms such as low energy, fatigue, poor sleep, brain fog, joint pain, and digestive issues. By lowering inflammation balancing blood sugars and essential hormones, and rebalancing the gut microbiome. Ultimately, this holistic approach aims to improve your overall quality of life.

How Rheumission incorporates food as medicine

Our nutritional strategy is meticulously crafted to boost your intake of dietary fiber and anti-inflammatory foods. We also use a strategic evidence based elimination diet approach to identify your food triggers to improve autoimmune symptoms related to foods and decrease flares. Our primary objective is to engage with you where you are in your food journey, understanding your individual needs and circumstances. Our clinical team, particularly our registered dietitians who have autoimmune expertise, are committed to crafting a personalized care plan that resonates with your comfort and readiness, moving as quickly or as slowly as you want.

We offer two scientifically-supported nutritional protocols developed collaboratively by our integrative rheumatologist and autoimmune-expert registered dietitians. These protocols are structured into three key phases:

Elimination
Gentle, personalized reintroduction
Maintenance

Each is designed to encourage a plant-focused dietary pattern, which has been shown to significantly contribute to disease remission and a heightened sense of overall well-being.

Your Journey, Our Support

Choosing to embark on this journey with Rheumission means you're not just adopting a new diet; you're embracing a lifestyle change that places you at the center of your health narrative.

Our team is here to provide you with professional guidance and the autonomy to decide which aspects of our protocols best suit your needs. This is not about prescribing a one-size-fits-all solution but rather about co-creating a path that you feel comfortable following and one that is sustainable in the long term.

In every step of your journey, Rheumission is here to support you, providing the knowledge, tools, and encouragement you need to succeed. Whether you're looking to alleviate specific symptoms, manage a chronic condition, or simply enhance your overall health, our approach is flexible and responsive to your personal health goals.

Conclusion: A Path Toward Better Health

By integrating food as a fundamental element of medicine, Rheumission aims to not only improve your physical health but also to enhance your mental and emotional wellbeing. It's about creating a sustainable, enjoyable lifestyle that supports your health goals and brings joy and vitality into your daily life.

We invite you to join us on this transformative journey, to explore the vast potential of food to heal and nourish not just the body, but the mind and spirit as well. Together, let's redefine what it means to live well, supported by a team that believes in your potential to thrive.

Through the Rheumission approach, discover the power of food to transform your health, one meal at a time. Let's move forward, with the confidence that we're not just making changes for today, but nurturing a healthier, more vibrant tomorrow.

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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About the Author

Jenifer Tharani is a registered dietitian, anti-inflammatory nutrition & lifestyle expert, and daughter of a chronic pain warrior. Jenifer has completed masters degrees focusing on probiotics from California Polytechnic State University & anti-inflammatory nutrition from Texas State University. Jenifer completed her dietetics internship from Emory University Hospitals. She currently lives in Los Angeles, California. Jenifer believes that following an anti-inflammatory diet should be easy, realistic and fun instead of overwhelming, time consuming or boring. Her nutrition approach is rooted in mindful eating, plant forward diet, and anti-inflammatory lifestyle pillars. She is extremely passionate about helping patients adopt an anti-inflammatory and gut healing eating pattern. She believes in helping patients living with autoimmune illnesses with making small sustainable lifestyle changes to help improve symptoms & overall quality of life. Jenifer’s mantra is “Give a Man a Fish, and You Feed Him for a Day. Teach a Man to Fish, and You Feed Him for a Lifetime”. Her nutrition coaching sessions are designed to empower you with nutrition education, provide you with accountability to take action and experience transformations, and experience its ripple effects in every aspect of your life.

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