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Rheumatology

Autoimmune Disease

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Kara Fitzgerald, ND, PhD
We have not made progress in our battle to ease suffering caused by autoimmune disorders. The National Institutes of Health estimates that between 14 and 22 million people in the United States have an autoimmune disease with the most common being systemic lupus erythematosus (SLE), multiple sclerosis (MS), type 1 diabetes, thyroid (Graves and Hashimoto), myasthenia gravis, scleroderma, and rheumatoid arthritis (RA). These disorders affect more women than men and are among the 10 leading causes of death for women in all age groups up to the age of 64. The physical, emotional, social, and financial burden of these diseases cannot be overstated.

Autoimmune disorders can be some of the most challenging illnesses to treat because etiology can be difficult to determine and disease progression can be complex and dangerous. With more than 80 different types of autoimmune disorders presently identified, the complexity begins with diagnosis. The wrong or delayed diagnosis can not only be frustrating for the patient but can also reduce the chance of successful treatment and possible remission.

Once a proper diagnosis is in place, conventional medicine looks to steroid and other drugs to help the patient manage symptoms. According to clinician, Kara Fitzgerald, ND, this is where an integrative approach can shine. We asked to her describe her clinical strategy.

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Fibromyalgia

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David Brady, ND, DC, CCN, DACBN
Fibromyalgia is a condition characterized by chronic widespread pain and fatigue that can be accompanied by additional symptoms, such as sleep disturbance, depression, anxiety, and/or irritable bowel. Fibromyalgia affects predominantly women, with a female to male ratio of 7:1. Diagnostic criteria for fibromyalgia were first developed in 1990 and have evolved over time.

David M. Brady, ND, proposes that the current diagnostic criteria lead to inappropriate diagnosis in a large number of patients whose symptoms are better explained by other causes. For example, musculoskeletal disorders, organic diseases, and functional metabolic disorders can all create chronic pain and fatigue. He suggests that the fibromyalgia diagnosis should be reserved for those who truly experience a global hypersensitivity to pain with underlying central nervous system dysfunction. He uses the term “classic fibromyalgia” to describe this subset of patients. In the following discussion, Dr. Brady explains his approach to the accurate diagnosis and treatment of classic fibromyalgia.

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Injection Therapy for Chronic Joint Pain

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JoAnna Forwell, ND, DAAPM
Musculoskeletal pain can result from chronic overuse injuries or acute injuries that fail to completely heal. Incompletely healed injuries become chronic, creating such conditions, as carpal tunnel syndrome, epicondylitis, Achilles tendonitis, patellar tendinopathy, or osteoarthritis to name just a few. Standard therapies are typically palliative, such as non-steroidal anti-inflammatory medications, corticosteroid injections, or physical therapy; surgery is considered when conservative treatments fail.

Regenerative injection therapies (RITs), including dextrose prolotherapy and autologous platelet-rich plasma (PRP), offer an alternative to standard therapies or surgery for chronic traumatic injuries. The goal of these therapies is to stimulate repair of injured tendons, ligaments, joints and other tissue. Prolotherapy has been in use for about 100 years, with modern protocols beginning in the 1950s. PRP injections are a more recent therapy, first used in the late 1980s. In this discussion, Dr. JoAnna Forwell shares insight from her clinical experience with RITs.

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Integrative Approaches to Neuroscoliosis

Marc Lamantia, B.S., M.S., D.C., DACNB
Scoliosis is defined as an abnormal lateral curvature of the spine, measuring 10° or more. Scoliosis affects 2-3% of the population, or an estimated 6 to 9 million people in the United States. Scoliosis can develop at any age, but most often progresses during the rapid growth of adolescence. In the United States, scoliosis is managed by orthopedic specialists, who “watch and wait” until the spinal curvature is significant enough to warrant bracing or surgery. In the conventional medical model, scoliosis is understood to be strictly a musculoskeletal condition that will not respond to nutritional, lifestyle, or other metabolic interventions.
 
In contrast to the conventional view of scoliosis, Dr. Marc Lamantia, D.C., approaches scoliosis as a whole-body disease—a disease that is influenced by internal and external epigenetic factors. In the following discussion, Dr. Lamantia explains that scoliosis is more accurately termed “neuroskeletal scoliosis.” He encourages integrative clinicians to become educated about this condition and to educate patients on the need for integrative care.

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Lyme Disease

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Ron Grisanti, DC, DABCO, DACBN, MS
Lyme disease is the most common vectorborne illness in the United States, with more than 25,000 new cases reported to the Centers for Disease Control and Prevention (CDC) in 2013. More precisely called Lyme borreliosis, it is caused by 1 of at least 300 different strains of the spirochete, Borrelia burgdorferi. The most well recognized vector of transmission is the Ixodes tick, but research suggests that fleas, flies, gnats, mites, and mosquitos might also transmit this disease to humans. Prompt recognition and treatment of early infection can lead to complete resolution, and medical authorities disagree about whether or not Lyme disease can become chronic.

Dr. Ron Grisanti has observed that untreated or ineffectively treated Lyme disease can progress to chronic disease that can affect the skin, joints, immune system, nervous system, or other vital organs. In the following discussion, he explains his approach to the identification and management of chronic Lyme disease.

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Osteoporosis

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John Neustadt, ND
The World Health Organization defines osteoporosis as a disease of low bone mineral density (BMD), diagnosed by a T-score of −2.5 or less. In the United States, more than 10 million people are living with osteoporosis, and that number is expected to increase to 14 million by the year 2020. Osteoporosis is a serious health concern because it increases the risk for fractures, leading to disabilities, chronic pain, or even death. Hip fractures are particularly debilitating, putting patients at a 20% risk of death within 1 year. It is estimated that the annual number of hip fractures in the United States will rise to 289,000 by the year 2030, making fracture prevention a priority in the treatment and management of osteoporosis. In this discussion, Dr. John Neustadt, ND, explains the importance of treating not only bone density but also bone flexibility to achieve the most important clinical endpoint in osteoporosis: fracture risk reduction.

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