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Intro: Riverside Healthcare puts the health and wellness information you need well within reach.

Taylor Leddin-McMaster (Host): Hello, listeners. Thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin-McMaster. Joining me today is rheumatologist Dr. Manan Dhingra, who is here to talk about invisible illness. Dr. Dhingra recently joined Riverside Healthcare, and this is his first time on the podcast. Welcome.

Dr. Manan Dhingra: Thanks for having me on.

Host: Thanks for coming in. Before we get into today's episode, we're going to take a quick break for a message about myChart.

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Host: And we're back. Dr. Dhingra, since this is your first time on the podcast, can you tell us a little bit about your background and your specialty in Rheumatology?

Dr. Manan Dhingra: Yeah, absolutely. So, you know, I did most of my training in the Midwest. I did my undergrad at Notre Dame and medical school at University of Illinois. And eventually, I did my fellowship in Rheumatology at the University of Missouri. So, I think I just became interested in Rheumatology and residency. It was a branch of internal medicine that really dealt with a lot of conditions that you could say you have to like put the puzzle together to diagnose the patient. But at the same time, you kind of develop relationships with the patient that are long-lasting, often for their whole lives. So, that's kind of how I became interested in it.

Host: Very interesting. Can you discuss the work that Riverside Rheumatology specialists do and the conditions that are often treated?

Dr. Manan Dhingra: Yeah, absolutely. So, we tend to deal with conditions that affect the joints, the muscles, the immune system. So often, we'll deal with systemic autoimmune or inflammatory diseases. So, examples of some of the things we treat can be rheumatoid arthritis, lupus, gout, psoriatic arthritis. All these things kind of fall under our care, and also some rare things like vasculitis, scleroderma. We often also just see patients that have chronic joint pain or chronic fatigue or things like fibromyalgia. So, a wide variety of things, I would say.

Host: Yeah. You mentioned some of those things that I know are classified as invisible illnesses. Can you explain what exactly an invisible illness is and why they're deemed invisible?

Dr. Manan Dhingra: Sure. Yeah. So, I would say that there are a couple of categories of invisible illness and Rheumatology. So, the first category would be, one, something like fibromyalgia, where you have symptoms that are present, often pain, fatigue. But on the outside, you don't have physical signs. You don't have swelling in the joints. You don't have things like rashes or anything. So, they can be pretty debilitating and pretty bothersome, but you don't always see those signs on the outside.

The other category I would see are illnesses, the majority of the things we deal with do have those outward signs, like swelling in the joints or certain kinds of rashes, sores in the mouth, things like that. But they can affect many different organ systems. Often, they can be fluctuating, so they can be difficult to diagnose. And so, they can kind of go a long time before being diagnosed and be invisible in that way that you may have this going on, but you can't really put together all the science of what's going on. So in that way, they can be invisible illnesses.

Host: Gotcha. Thank you for that explanation. You had talked about a few different types already, but what are some of the common invisible illnesses that you see and how are they diagnosed?

Dr. Manan Dhingra: Sure. So, I would say that a lot of our conditions that we see in Rheumatology, they can be difficult to diagnose because they often have overlapping symptoms. So, almost all of them will have joint pain and almost all of them will have fatigue. And then, to specify what exactly is going on, often we'll try to figure out the pattern that's going on. So, we look at the pattern of the joints that are affected, what time of day are they affected. Is there swelling going on in the joints? And we'll often check some lab work, like, for example, antibodies that can be very helpful in diagnosing something like rheumatoid arthritis.

Sometimes we'll add some imaging, and we'll kind of look at all the organ systems and see if they fit a certain pattern. And that's how we diagnose most of our illnesses. If all of the workup tends to be negative, and on the outside there aren't obvious signs and we've done a workup to rule other things, then we think about the other kind of invisible illness, which would be something like fibromyalgia. So, generally, that's the way we proceed.

Host: Okay. This next question is kind of similar to what you had just answered. How does a rheumatologist differentiate between conditions that may present similar symptoms but are considered invisible illnesses? So, I'm curious, for example, a personal example for me is that I had some blood work done at one point that was showing that I might have rheumatoid arthritis. I had to come back, get it done. A few months later, it was found that that wasn't the case. So, they had to rule that out. Eventually, I came to find out that I do have fibromyalgia. So, it was eliminating some things. So, you talked about those overlapping symptoms and how do you know how to differentiate between those? It's very interesting.

Dr. Manan Dhingra: Yeah. I think an important thing to keep in mind in Rheumatology is that lab work is useful, but it's usually not going to give you the diagnosis by itself, right? So, we look at the whole picture and especially the physical exam to see if the picture fits with a certain diagnosis. So, this can be confusing for some people because in other conditions. Once you have the lab work, you have the diagnosis, right? So for example, if your blood sugars are elevated beyond a certain point, you have diabetes regardless of what else is going on, right? And rheumatology doesn't always work the same way. That can be a little bit frustrating for patients because we're often dealing with some ambiguity. But oftentimes, we'll kind of go step by step and include, in addition to the exam and the history, some lab work to kind of see if the picture fits with a rheumatologic illness or not.

Host: Okay. Well, great. Before we continue our conversation, we're going to take a moment to talk about the importance of primary care.

At Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at riversidehealthcare.org/acceptingnew. From annual screenings to well checks and everything in between. Having a primary care provider that you can trust makes all the difference.

And we're back talking about Rheumatology. So, I'm curious, what role does Rheumatology play in diagnosing and treating invisible illnesses?

Dr. Manan Dhingra: Sure. I think we can play an important role in directing the patient to one direction or another often. So, we will start a workup to see if it seems to be a rheumatologic problem, if there seems to be signs of an inflammatory problem or an autoimmune problem going on, and decide whether it seems to be more of that sort of issue or for example another sort of issue, like an infectious issue. And once we have a diagnosis, we have a lot of things in our arsenal to halt the disease or prevent future damage. So oftentimes, once we make the diagnosis of something like rheumatoid arthritis or lupus that has often gone long, undiagnosed or untreated, we can really make a huge impact in people feeling remarkably better and prevent a lot of future damage down the road to joints and to other body parts.

Host: You mentioned the arsenal of options to treat and handle these illnesses. What are some of the current treatment options you're working with to manage these illnesses?

Dr. Manan Dhingra: Yeah, there's been a lot of development and options for treatment and research in this area. So, there's new medications coming out all the time. So when we think about options for treatment, we think about, you know, things that have been present for a long time, like things like NSAIDs or steroids. We also think about conventional disease-modifying drugs. So these would be things like methotrexate or hydroxychloroquine, and all of these medications are typically taken by mouth. And then, on the other hand, we also have newer medications, and these are called biologics. Most times they're either taken by an injection every few weeks or an infusion, and they've sort of just really revolutionized the care of many of our diseases and really resulted in dramatic improvement in quality of lives in a lot of our patients.

Host: Yeah, that's always exciting to see the developments and how these things evolve and make it better for patients to live healthier lives. Scaling it back to Rheumatology kind of as a whole, what are some preventative steps that people can take against rheumatic diseases such as arthritis that affect the joints, muscles, bones, and skin?

Dr. Manan Dhingra: Yeah. So, the first thing to keep in mind is we can't always prevent, People from developing an autoimmune disease. The thing that's going to be the most helpful or impactful is going to be avoiding smoking, maintaining a healthy weight, staying active, and eating healthy. So, those are the things you should focus on. But again, you know, it's not always in our control.

Host: Right. Yeah. Is there anything else you would like listeners to know about Rheumatology or invisible illness, anything of that nature?

Dr. Manan Dhingra: Sure. I would just say don't be afraid to see a rheumatologist if you're having issues like pain that's not getting better, swelling in the joints, stiffness in the morning, lasting several hours, or unexplained things like fevers that are unexplained or rashes or mouth sores or things like that.

Oftentimes, the result of seeing a rheumatologist is that we rule out certain things. That's the most important thing we do, right? And that actually can be a very important step. It can give you a lot of clarity and confidence in managing your symptoms. So, that can be a really important step in treatment.

Host: Yeah. Well, thank you so much for that insight, and I know it's a little delayed, but welcome to Riverside. We're happy to have you. And thank you listeners for tuning into this episode today. To learn more about Rheumatology at Riverside Healthcare, go to riversidehealthcare.org/services.