by REBEKAH PIERCE
Sponsored by Central Florida Health Care
Chronic pain, persistent swelling, and mysterious symptoms can sometimes feel like an unsolvable puzzle with multiple missing pieces.
But for rheumatologists, these are often the clues that lead to life-changing answers. Specializing in autoimmune and inflammatory conditions, rheumatologists play an indispensable role in diagnosing and treating diseases that impact not just joints, but in many cases, the entire body.
Kavita Khorran, a physician assistant at Central Florida Health Care who specializes in rheumatology, explains that many patients come to her office looking for answers because they’ve been experiencing pain for several years, or “weird” symptoms that just can’t be explained with other diagnoses.
“A lot of times we get what we call ‘zebra cases’ as well,” she says. “They never got a clear diagnosis on what they have. And it’s very rewarding, being able to sometimes provide those answers for your patients.”
There’s no simple checklist of what might make someone a good candidate for a visit to the rheumatologist, but Khorran says a few common symptoms or signs include active swelling in the joints (predominantly in the morning, when they wake up), swelling that persists for more than a week at a time, rashes that don’t go away, extreme fatigue, and painful joints that are tender to the touch.
“Go get screened as soon as you feel like you’re having pain,” she says. “Delays in treatment can cause permanent damage. Early intervention is the best; we have targeted treatments now to prevent permanent damage and modify disease progress earlier, rather than later.”
Rheumatology covers a broad swath of conditions, from the common (like rheumatoid arthritis or lupus) to those that might be less expected (like gout, psoriatic arthritis, or osteoporosis). These conditions are complicated to treat and even harder to diagnose.
“Usually, a primary care doctor will try to assess what’s going on, [then] refer to us. Many diseases aren’t just one [positive] lab test [to diagnose], not just one treatment, but a variety of symptoms, conditions, manifestations, along with lab work to make a clinical decision,” she says.
“A lot of these diseases go untreated for a long time. [We] can screen when you come in, rule out other diseases through bloodwork, make a clinical assessment based on presentation, and hopefully start you on treatment to prevent further joint damage.”
It’s not just joint damage that untreated rheumatic diseases can cause, either. There are also risks to organs. Khorran explains that untreated conditions like lupus can lead to kidney dysfunction, among other problems.
Due to the complexity of treating and diagnosing these diseases, Khorran typically works closely with other healthcare providers, from nephrologists to ophthalmologists to pulmonologists. But again: timing is everything.
“We have the privileges and advantages of new medical treatments that can modify the disease early on and prevent permanent damage,” she says.
“If someone does have rheumatoid involvement of the lungs, that’s where a multispecialty, multifactorial approach comes in. We’ll get them to see pulmonologists, scan with chest CTs, PFT testing, and test for lung involvement.”
For patients who are hesitant to book an appointment, Khorran encourages them to take the first step.
“Why not rule something out, [especially] if you haven’t had answers before and these conditions are affecting your daily functioning? We want to prevent permanent joint damage. The earlier you get treatment, the earlier you’re evaluated, it’s better for your disease’s prognosis. We have the treatment and medications to prevent these patients from getting to that point.”
Central Florida Health Care sees both insured and uninsured patients and provides consistent access to care regardless of ability to pay.
“We are also expanding our clinic and opening a second clinic early next year,” Khorran says. “We have a huge need and a huge population [of people] out here who have been dealing with pain for a while.”
She says the best part of her job is building lifelong connections with her patients and finally giving them the answers they deserve.
“It may be a journey – sometimes answers [don’t come] overnight.”
She explains that there are lots of new drugs coming to market and in trials, with some therapies and treatments showing not just improvement but complete remission.
“It’s an ever-evolving field. Research is discovering more and more [options] every day.”
“Just have hope. This is not the end all, be all. We have answers that can help with pain and improve quality of life.”