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What does a specialist in rheumatology do?

A rheumatologist is an internal medicine specialist who received additional training for the correct diagnosis and treatment of diseases of the musculoskeletal system, including autoimmune diseases. These diseases usually affect the joints, muscles, bones, tendons; however, they can also affect the skin, internal organs, and practically any structure of the human body.

The most common symptoms that occur in patients with rheumatological diseases are pain (muscles, tendons, or joints), swelling, fatigue, and skin outbreaks (a very typical example of this symptom is psoriasis).

Autoimmune diseases can occur at any time in life, from birth to old age. However, they are more commonly present between 20 and 40 years of age. They also occur more frequently in women, due to hormonal factors.

The diagnosis of rheumatological diseases is not always easy to obtain, as a specific disease can present in different ways and may not even be detected by laboratory tests that are available for this purpose.

When should you consult a rheumatologist?

Anyone can experience joint or muscle pain intermittently. When the pain does not resolve and becomes chronic, an appointment with a rheumatologist is necessary; especially if there is a family history of rheumatological disease or if symptoms continue to worsen over time. A rheumatological disease without diagnosis and treatment can produce permanent damage to joints, muscles, and internal organs.

In your appointment with the rheumatologist, a complete medical history and musculoskeletal examination will be performed; if necessary, blood and radiological tests (X-rays, tomography, magnetic resonance) will be performed. Once all the information has been collected, the rheumatologist can make a correct diagnosis, which leads to timely prognosis and treatment. In some cases, the diagnosis can be made at the first visit, but in other more complex cases, it may take more time.

Often, the rheumatologist works in conjunction with other specialists such as orthopedists, internists, nephrologists, cardiologists, and surgeons, among others.

What are biological medications used in rheumatology?

Rheumatology is a branch of medicine that deals mainly with diseases that affect different components of the musculoskeletal system, including joints (the point where two bones meet), bones, tendons, and muscles. The field of rheumatology also includes systemic autoimmune diseases, which, due to an overactive and dysfunctional immune system, can cause inflammation potentially anywhere in the human body, including internal organs such as lungs, heart, and kidneys, among others. Some examples of these diseases are rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, psoriatic arthritis, scleroderma, and ankylosing spondylitis.

Systemic inflammation in the aforementioned diseases can also affect the musculoskeletal system components, and for this reason, arthritis is a very common symptom in our patients. Therefore, the medications used in rheumatology work by telling the immune system to start functioning correctly. This procedure could also be called "suppressing" the immune system; therefore, patients who take these medications are known as immunosuppressed patients.

Over the years, medications used in rheumatology have been evolving with the aim of minimizing adverse effects. The oldest medications used in rheumatology are called steroids, which are widely used today and are also known as prednisone, prednisolone, dexamethasone, betamethasone, and deflazacort, among others, which are very useful in managing systemic rheumatologic diseases. Unfortunately, they also produce serious adverse effects, especially with chronic use, including an increased risk of infections, osteoporosis, diabetes, high blood pressure, and cataracts in the eyes, to name a few. For this reason, despite steroids still being widely used in the world of rheumatology, the aim is always to use the lowest possible dose for the shortest possible time.

Over the years, medications that can fulfill the role of steroids without producing the aforementioned serious adverse effects were identified. Medications such as hydroxychloroquine (Plaquenil), methotrexate, and leflunomide (Arava), also known as "steroid savers," fulfill this purpose and have contributed greatly to the well-being of our patients, as they can control the disease with possible adverse effects that are much less severe than steroids and much more manageable if they occur. Unfortunately, there is still a group of patients who do not respond well to these medications and who continue to suffer the consequences, either due to the disease they suffer from or the possible adverse effects of steroids.

It was in the early 2000s that the first "biological" medication for use in rheumatology came on the market, called infliximab (Remicade). Subsequently, new medications of this type continued to come on the market, including medications such as etanercept (Enbrel), adalimumab (Humira), and later rituximab (Rituxan). These medications, by blocking more specific parts of the immune system (as opposed to steroids), revolutionized the world of rheumatology and gave hope to patients for whom older medications were not working. Over the years, and up to the present day, new medications of this type continue to come on the market, which have strengthened the therapeutic arsenal of rheumatologists and improved the quality of life of patients with systemic rheumatologic diseases.

Biological medications can be administered in different ways, including orally (pills), intravenously (infusions into the vein), and subcutaneously (injections under the skin). As long as they are used under strict supervision by a rheumatologist, they are widely safe and effective.

About Our Rheumatology Center

At the Metropolitan Hospital, we have a team of pharmacists, nurses, and doctors with extensive experience in the use and administration of these medications. We also facilitate their approval by the different insurance companies that the hospital works with. In this way, we seek to offer the Costa Rican population the most modern treatment for rheumatologic diseases, at the level of international standards, and improve the quality of life and life expectancy of our patients who suffer from rheumatologic diseases.

Who is our director?

Dr. Bonilla Trejos graduated from the School of Medicine at the University of Costa Rica in 2000. After working for a while as a general practitioner in Río Frío de Sarapiquí and at the Integrated Clinic of Tibás, he traveled to Syracuse, New York where he completed his specialties in internal medicine and rheumatology at Upstate Medical University of the State University of New York.

He has also worked as a rheumatologist at the Veterans Hospital in Pittsburgh, Pennsylvania, and at the San Juan de Dios Hospital. He was also a university professor at the University of Costa Rica and in the postgraduate program in rheumatology at CENDEISSS. More recently, he also worked as a university professor at SUNY Upstate Medical University.

Dr. Bonilla has participated as a researcher in multiple clinical trials where systemic lupus erythematosus has been his main interest. He has multiple publications in international medical journals. In the field of rheumatology, he treats multiple diseases related to musculoskeletal disorders and autoimmune disorders, including joint pain, generalized pain, fibromyalgia, gout, lupus, psoriatic and rheumatoid arthritis, among others.

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