Dr. Claro Palma is the only rheumatologist in the Cedar Falls/Waterloo area. His office in Cedar Valley Medical Specialists' Rheumatology Department is located at United Medical Park on West Ridgeway Avenue in Waterloo.
Rheumatology is a subspecialty of internal medicine. A rheumatologist undergoes an additional two to three years of training in order to be able to diagnose and treat the various disorders associated with musculoskeletal diseases and systemic autoimmune conditions commonly referred to as “rheumatic diseases.” These diseases can affect the joints, muscles and bones and cause pain, swelling, stiffness and deformity.
“The autoimmune conditions occur when the immune system sends inflammation to areas of the body when it is not needed, causing damage or other symptoms,” Dr. Palma says. The diseases also can affect the eyes, skin, nervous system and internal organs.
“Causes also may include bad lifestyle choices or injuries. The conditions may include osteoarthritis, tendon injuries, tendonitis, nerve problems due to pinched nerves, and immune disorders like lupus and scleroderma. Some other conditions are gout, vasculitis and inflammation of the blood vessels — depending upon what organ is involved, you can have lung inflammation, heart inflammation or brain inflammation,” adds Dr. Palma.
He explains that diagnosis involves visiting with the patient, discussing symptoms, getting a family history, and interpreting the information in order to make a reasonable assessment. “Additional testing includes testing of the blood and ordering X-rays or MRIs, and sometimes requesting tissue biopsies, depending upon what organ might be involved,” he adds. “Certain features will be identifiable in the biopsy, resulting in a diagnosis.”
Rheumatologists do not perform surgery, though certain complications of a condition can lead to surgery. Joint deformities or inflammation in the breathing passages, for example, can lead to further invasive treatments, such as dilating the trachea or esophagus if the passageways have narrowed. Non-surgical care involves the use of antibodies.
“There are a lot of new antibodies that identify rheumatoid arthritis,” Dr. Palma says. “There now are more specific tests for diagnosing lupus. The testing is easier to quantify. Testing previously was done on cell cultures. Now it’s an antibody test.
“The treatments have changed a lot in that we now have developed monoclonal antibodies. The antibodies are engineered to target specific signals that the body uses to trigger certain inflammations in an abnormal way. These signals are increased in specific conditions. So if you can block a signal with antibodies assigned to only interact with that particular signal, then you can block the inflammation. The antibodies are usually given via injection,” Dr. Palma says.
Still, some conditions have not had antibodies assigned or the antibodies still don’t work as well as some of the old medications, such as chemotherapy drugs, which are used for certain types of vasculitis.
“Over the past 10 to 15 years, we have identified more than a dozen of these specific signals produced by different cells,” Dr. Palma says. “Progress is being made, and we have more options for treatments.”
Science continues to look for more treatment options. Dr. Palma says a lot of genes are being identified as risk factors for certain conditions.
“We might be able to use genetic testing to identify conditions ahead of time,” he says.
Dr. Palma encourages his patients to work closely with physical therapists or at least to participate in a recreation program or some other exercise program offerings. His patients also might need to have consultations with pain doctors or orthopedists.
“If you keep moving, you do better,” he says. “It’s not a cure, but you will feel better.”