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Diagnosing and Treating Autoimmune Diseases

June 15, 2018

Our doctors take a multidisciplinary approach

If there is a common thread that binds together the multitude of rheumatic and autoimmune diseases, it’s that the diversity and complexity of these conditions can make them difficult to diagnose. But at Overlook’s Institute for Rheumatic and Autoimmune Diseases (IRAD) – the only hospital-based facility of its kind in New Jersey – doctors take a comprehensive approach to delivering concise and accurate diagnoses and treatment plans.

Read “Living with Lupus – Sharon’s Story” below >

Directors Neil Kramer, MD, and Elliot Rosenstein, MD, describe IRAD as “a multidisciplinary center without walls,” where several different subspecialists come together to meet the needs of patients. “These diseases regularly affect multiple organ systems, so our team of rheumatologists coordinates the diagnosis and treatment of our patients with specialists in those areas,” explains Dr. Rosenstein. “Atlantic Medical Group has made it easy to ensure that all of those pathways to care are in place and that our patients are seen by quality specialists.”

The rheumatologist team at IRAD (in addition to Drs. Kramer and Rosenstein, the team includes Nicholas Cannarozzi, MD; Nicole Daver, DO; Nikolay Delev, MD; Jeffrey Greenberg, MD; Sneha Pai, MD; Sheetal Patel, MD; Thomas Nucatola, MD; and Andrew Weinberger, MD) meet weekly to share insights, and the cases of new patients with challenging clinical problems are presented to the entire group. The immeasurable value of this roundtable approach truly changes the landscape of rheumatic and autoimmune diseases.

“Conditions that were once considered debilitating or even fatal are controllable, and most patients are now able to resume or continue their regular activities of daily living with little or no adjustments required,” says Dr. Kramer.

Living with Lupus – Sharon’s Story

Surviving – and thriving – with an autoimmune disease

This summer, Sharon Snyder will celebrate her 58th birthday and all the joys that come with it. But for nearly two-thirds of her life, she has coexisted with lupus, an autoimmune disease that can affect many different body systems, from joints, skin and blood cells to kidneys, brain, heart and lungs. Like other systemic autoimmune diseases (of which there are many), lupus occurs when the body’s immune system attacks its own tissues and organs, and – as is all too common with these disorders – can be difficult to diagnose because its signs and symptoms often mimic those of other ailments.

For Sharon, too, the path to diagnosis included the pitfalls of two misdiagnoses: rheumatoid arthritis and mixed connective tissue disease. It was not until 1983, when she sought out a second opinion from Neil Kramer, MD – currently director, with Elliot Rosenstein, MD, of Overlook’s Institute for Rheumatic and Autoimmune Diseases (IRAD) – that she learned she had lupus. “Dr. Kramer diagnosed me within the first few months of seeing him. It was a scary time,” Sharon says of her life 35 years ago. “I was young. I had significant pain. And this diagnosis was pretty frightening. How was it going to impact the life I wanted to live? This disease is complicated, but Dr. Kramer worked with me to develop a treatment plan that preserves my quality of life.”

Over the years, that plan has changed, whether in response to shifts in her condition, stage of life (under Dr. Kramer’s care, for example, she was able to come off certain medications in the early ‘90s when she and her husband wanted to start a family), or advances in medications. “There have been short-term plans and long-term plans, but the goal has always been to follow the treatment plan that finds the right balance of medication and lifestyle,” says Sharon.

When Sharon’s condition flares – times when her lupus symptoms worsen for a while – she often notices an increase in arthritic sensations and sometimes fluid retention in her feet (which can signal lupus nephritis, involving the kidneys), but over the years, symptoms have been as vague as a sharp pain in her rib cage (for a while she thought she may have pulled a muscle, but it turned out to be pleurisy, inflammation of the lungs). Other times, Sharon does not notice any physical change, but Dr. Kramer will detect a difference in her blood work and adjust her treatment plan accordingly.

“Lupus is so mysterious and can manifest itself in so many different ways, some of which I can detect and others I might not sense at all,” says Sharon. “I’ve learned throughout the course of my disease to be very aware of my body and what felt normal for me, and when something felt outside of that norm, I had it checked out right away. I also have regular quarterly visits with Dr. Kramer to check all of my counts, which help us stay on top of any flares. It has been a very effective way to manage my lupus.”

Despite 35 years of living with lupus, Sharon has maintained a positive attitude and is as committed to her mental health as to her physical health. “I tend to be a positive person,” she says. “From the very beginning, I decided to deal with the ups and downs of my disease as best I could and to live each day to the fullest. I have followed Dr. Kramer’s medical advice, as well as the advice of my other medical specialists, and always took the medications prescribed to me.”

Sharon has not allowed her lupus to sideline her from the life she wants to lead. She follows a healthy diet, exercises, goes bike riding, and enjoys traveling. (She is also diligent about protecting herself from the sun, a frequent trigger for flares among many patients with lupus.) She also practices meditation, yoga and tai chi to re-energize herself and remain focused on her health and wellbeing.

“I feel meditation and exercise were key activities to help me stay physically, mentally and spiritually healthy. I am convinced it was an important aspect of maintaining my good health,” she says. “I think it is important that patients are actively engaged in their own disease management in partnership with their doctor. With Dr. Kramer’s expert advice and guidance, I have been able to achieve an excellent quality of life over the past 35 years. For that, I am very grateful.”