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By Dr. Jane B. Ayala, FACR and Dr. Thomas A. Rennie, FCR Board Certified in Internal Medicine and Rheumatology DMARDs are a group of medications used to treat rheumatoid arthritis (RA) by slowing down or stopping the disease process—not just masking symptoms like pain or stiffness. They work by calming the overactive immune system, reducing inflammation inside the joints, and helping prevent joint damage and deformity over time. Types of DMARDs 1. Conventional (Traditional) DMARDs These have been used for many years and are usually the first-line treatment for RA. Common examples: Methotrexate (Trexall, Rasuvo): The most commonly prescribed DMARD. It helps control inflammation and slows joint damage. PEARL: we use low-dose Methotrexate different than the chemotherapy dosing, sometimes talking about Methotrexate is scarier than taking it. We supplement folic acid/folate to prevent side effects. Sulfasalazine (Azulfidine): Often used with methotrexate for added benefit. Leflunomide (Arava): Blocks immune cell activity that causes inflammation. Hydroxychloroquine (Plaquenil): A mild DMARD that helps control symptoms, often used in combination with others. These medications may take 6–12 weeks to show improvement. 2. Biologic DMARDs Biologics are targeted therapies made from living cells. They block specific parts of the immune system involved in RA inflammation. Examples include: TNF inhibitors: etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) IL-6 inhibitors: tocilizumab (Actemra), sarilumab (Kevzara) B-cell or T-cell targeted drugs: rituximab (Rituxan), abatacept (Orencia)   They work differently than traditional DMARDs and are often used when methotrexate alone isn’t enough. 3. Targeted Synthetic DMARDs (JAK Inhibitors) These are oral medications that block enzymes (JAKs) involved in the immune response. Examples: Tofacitinib (Xeljanz) Upadacitinib (Rinvoq) Baricitinib (Olumiant) They act quickly and can be used if traditional or biologic DMARDs aren’t effective.   Monitoring and Side Effects Because DMARDs affect the immune system, regular blood tests are needed to check: Liver and kidney function Blood counts Infection risk Common side effects may include nausea, fatigue, or mild liver irritation, but serious side effects (like severe infections) are possible. Key Takeaways DMARDs are the foundation of rheumatoid arthritis treatment. They help prevent long-term joint damage, disability, and improve quality of life. The most important thing is to start early and continue regular follow-ups with your rheumatologist to monitor your progress and adjust medications as needed.  

By Dr. Jane B. Ayala, FACR and Dr. Thomas A. Rennie, FCR Board Certified in Internal Medicine and Rheumatology Inflammation plays a central role in many autoimmune and rheumatologic conditions. While there is no single “anti-inflammatory diet,” certain food groups are consistently associated with supporting the body’s ability to regulate inflammation. As discussed in the Autoimmune Protocol (AIP) diet, nutrition is only one piece of the puzzle. Still, choosing foods that support immune balance may help reduce inflammatory burden over time. Below are key categories of foods commonly included in inflammation-conscious eating patterns. Omega-3 Fatty Acids Omega-3 fatty acids are among the most well-studied nutrients associated with inflammation regulation. They are found naturally in fatty fish such as salmon, herring, mackerel, sardines, tuna, striped bass, and anchovies. These can be consumed through whole foods or, when appropriate, through fish oil supplements. Pearl: Some fish oil supplements are marketed as premium or superior at a high cost. A reliable brand with clearly listed ingredients and reasonable capsule size is often sufficient. Comparing labels matters more than price. For vegetarians and vegans, plant-based omega-3s are also available. Nuts and seeds are common dietary sources that can contribute to overall intake. Vitamin C and Other Antioxidants Vitamin C is a powerful antioxidant. Antioxidants help address cellular stress that can contribute to inflammatory processes. Vitamin C is abundant in fruits and vegetables, including oranges, tangerines, and bell peppers. Other antioxidant-rich foods include blueberries and açaí berries. Antioxidants work by helping neutralize oxidative stress, which is one of several pathways involved in inflammation. Polyphenols Polyphenols are naturally occurring compounds found in many plant-based foods. They are one reason dietary patterns like the Mediterranean diet emphasize colorful fruits and vegetables, whole grains, and olive oil. Foods and beverages rich in polyphenols include coffee, tea, dark chocolate, olive oil, and a wide variety of fruits and vegetables. These compounds are associated with protective effects that support inflammation regulation and overall metabolic health. Gut-Healthy Foods and the Microbiome The gut microbiome plays a significant role in immune function. In fact, approximately 80 percent of the immune system is associated with the gastrointestinal tract. Supporting a healthy balance of beneficial gut bacteria may help keep inflammation in check. This is often done through a combination of probiotics and prebiotics. Probiotics are live microorganisms found in fermented foods such as kombucha, kefir, and kimchi. Not all fermented foods contain live probiotics, so it is important to check labels. Yogurt and cottage cheese, for example, should list live active cultures on the packaging. Pearl: If choosing a probiotic supplement, refrigerated options often contain more stable live cultures. Prebiotics are types of dietary fiber that nourish beneficial gut bacteria. Foods rich in inulin, such as asparagus, bananas, chicory, and Jerusalem artichokes, help support a healthy and diverse microbiome. Putting It All Together Among well-known dietary patterns, the Mediterranean diet is often considered one of the most supportive for managing inflammation. It naturally emphasizes omega-3 fatty acids, antioxidant-rich fruits and vegetables, polyphenols, fiber-rich foods, and healthy fats like olive oil. While no diet can replace medical care or serve as a cure for inflammatory conditions, thoughtful food choices may complement overall health strategies and support long-term well-being.

By Dr. Jane B. Ayala, FACR and Dr. Thomas A. Rennie, FACR Board Certified in Internal Medicine and Rheumatology The Autoimmune Protocol (AIP) diet is a specialized version of the Paleo diet designed to help reduce inflammation, support gut health, and identify foods that may trigger immune reactions in people with autoimmune conditions.  It’s meant to be followed short-term (usually 4–8 weeks) as an elimination phase, followed by a gradual reintroduction phase to identify which foods your body tolerates. PLEASE NOTE: the only diet that has been so far proven to help with Rheumatoid Arthritis and endorsed by trials and American College of Rheumatology (ACR) has been the Mediterranean Diet.  Remember that each person is unique and what works for you might not work for someone else.  Also, there is not ONE uniform AIP protocol.  How the AIP Diet Works The AIP diet focuses on: Reducing inflammation by removing foods that may irritate the gut or trigger the immune system. Healing the gut lining, which may help reduce immune overreaction. Reintroducing foods slowly to find personal triggers. Phase 1: Eimination Phase During this phase, you remove potentially inflammatory foods such as: Foods to Avoid: Grains (wheat, rice, oats, corn) Legumes (beans, lentils, soy, peanuts) Dairy products Eggs Nuts and seeds Nightshade vegetables (tomatoes, peppers, eggplant, white potatoes) Processed foods, refined sugars, alcohol Coffee and food additives Foods to Focus On: Lean meats and fish (preferably grass-fed or wild-caught) Organ meats and bone broth Vegetables (except nightshades) Fruits (in moderation) Healthy fats (olive oil, coconut oil, avocado) Fermented foods (sauerkraut, kombucha) Herbs and non-seed spices This phase is followed for about 30–60 days, or until you notice improvement in symptoms like fatigue, joint pain, or digestive issues. Phase 2: Reintroduction Phase After your symptoms stabilize, you reintroduce foods one at a time, every 3–5 days, to see if they trigger any flare-ups. If a food causes pain, fatigue, or digestive upset, you remove it again and try later. This helps you create a personalized anti-inflammatory diet that’s sustainable long term. Potential Benefits Include: Reduced inflammation and joint pain Better digestion and gut function More stable energy levels Improved sleep and mental clarity However, results vary — some people experience significant improvement, while others notice minimal change. Cautions and Considerations The AIP diet is restrictive, so it can be hard to follow long term. It may lead to nutrient deficiencies if not carefully planned. It’s best done under the supervision of a physician or registered dietitian familiar with autoimmune diseases. It’s a complementary approach — it should not replace medications like DMARDs or biologics that control disease activity.

Hydroxychloroquine is a medication originally developed to treat malaria, but for many years it has been a core treatment for autoimmune diseases like lupus, rheumatoid arthritis, and some inflammatory arthritis conditions.

Rheumatologists are specialized physicians who diagnose, treat, and manage autoimmune and complex musculoskeletal conditions. They address systemic autoimmune diseases like lupus, rheumatoid arthritis, Sjögren’s, and scleroderma, as well as joint and musculoskeletal disorders such as gout, tendinitis, and bursitis. Using detailed history, physical exams, lab tests, and imaging, they develop personalized care plans to reduce inflammation, prevent organ damage, and preserve joint function, helping patients regain quality of life.

Rheumatoid Arthritis, often called RA, is a chronic autoimmune disease. That means your immune system—which normally protects you from infections—mistakenly attacks your own joints. This causes inflammation in the lining of the joints (called the synovium), leading to pain, swelling, stiffness, and sometimes warmth or redness.

Autoimmune diseases occur when the immune system mistakenly attacks healthy tissues, causing chronic inflammation and tissue damage. They may be systemic (affecting multiple organs, e.g., RA, lupus, Sjögren’s, scleroderma) or organ-specific (e.g., thyroid disease, type 1 diabetes, MS). Triggers include genetics, infections, medications, hormones, and environmental exposures. Symptoms vary but often include fatigue, joint pain, rashes, or organ dysfunction. Early detection and treatment with DMARDs, biologics, or JAK inhibitors can prevent long-term complications and significantly improve patient outcomes.

Sjögren’s syndrome is a chronic autoimmune disorder where the immune system attacks moisture-producing glands, primarily affecting the eyes and mouth. Common symptoms include dry eyes, dry mouth, fatigue, joint pain, neuropathy, and interstitial lung disease. Diagnosis involves blood tests, eye exams, and sometimes a lip biopsy. While there is no cure, management focuses on symptom relief and maintaining quality of life through artificial tears, saliva substitutes, medications like hydroxychloroquine, dental care, and immune support. Early detection and a tailored care plan can significantly improve daily functioning for patients.

Inflammation is the body’s natural defense mechanism, but it can be acute and healing or chronic and damaging. This article explains that inflammation often does not correlate directly with pain and can manifest as stiffness, fatigue, brain fog, flu-like symptoms, or numbness. Causes include infections, autoimmune diseases, injuries, metabolic disorders, environmental toxins, and more. Rheumatologists use lab tests (CRP, ESR, ANA, RF, anti-CCP) and clinical evaluation to detect and manage inflammation. Treatment combines lifestyle strategies, pharmaceuticals, and topicals to control symptoms and protect tissues, with topicals offering targeted relief and fewer systemic side effects.

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, severe fatigue, sleep disturbances, cognitive dysfunction (“fibro fog”), and various overlapping symptoms such as IBS, headaches, and bladder issues. Unlike autoimmune diseases, it does not cause inflammation or tissue damage; instead, it stems from central sensitization, where the nervous system overreacts to pain signals. Diagnosis is clinical, using ACR criteria and symptom scoring. Treatment is multidimensional—focusing on sleep optimization, graded exercise, CBT, mind-body therapies, and medications like SNRIs and pregabalin. With proper management, patients can achieve meaningful relief and maintain quality of life.

This article explains the key tests rheumatologists order to diagnose autoimmune and inflammatory diseases. Because symptoms often overlap, doctors use a combination of bloodwork (ANA, CRP, ESR, complement levels, CK), specific autoantibodies (like anti-dsDNA, anti-SSA/SSB, RF, anti-CCP), urine tests, and imaging (X-ray, ultrasound, MRI) to identify inflammation, pinpoint the disease, and check for organ involvement. No single test provides a full answer—rheumatologists interpret them together to build an accurate picture of what’s happening in the body. Patients are encouraged to ask questions and stay engaged in understanding their results and treatment plan.