For Your Information

Patients have told us that topical Voltaren which is now available over the counter (no prescription) is cheaper at Bed Bath and Beyond compared to local pharmacies. Remember to use one of their 20% discount cards you get in the mail or can download from their website. Also, Costco and Sam’s Club have low priced Advil or Aleve if you are willing to buy in bulk.

One of the best prescription savings we have seen is with for those of you who do not have a prescription plan. They ask for your zip code and after you enter the name of the drug, you are provided with participating drug stores in the area and what the medication will cost. Savings can be significant.

A Rheumatology View of Covid

For the last 6 months, it has been difficult for all of us to think of anything else other than Covid as our world has been turned upside down to borrow a phrase from Hamilton. As rheumatologists, we have our own particular view of Covid. Other than the unfortunate politicizing of social distancing, most of the world understands that this is vital if we are to survive this pandemic. Wearing masks, frequent hand washing, staying an appropriate distance from others and quarantining when necessary is vitally important. Avoiding prolonged exposure to others in non-ventilated rooms is obviously worthwhile. We have learned much in the last 6 months and the turnaround in former hot areas like New York City teaches us that we can do it but unfortunately at huge economic sacrifice for many. As we often say, “Listen to Fauci”.

In our office, we are using HEPA filtering which significantly reduces the amount of virus particles in the air. Questioning patients as to travel and having temperatures taken makes it a considerably safer place then many (i.e. supermarkets). We also continue to offer TeleMed visits which provides sufficient information in many cases but obviously does not work when infusions of medications, joint aspiration and injections are necessary. We now know that neither the diseases we typically treat nor the medications we use are risk factors for Covid. Identified risks are obesity, lung disease, vaping, smoking, and diabetes.

We have learned that many of the deaths cause by Covid have less to do with overwhelming infection and more to do with our bodies ‘accelerated inflammatory response to the infection. This is commonly referred to as cytokine storm where the immune system essentially goes haywire trying to eliminate Covid but unfortunately ends of damaging the endothelial cells which line the insides of blood vessels. Damaged blood vessels are more prone to promote clots throughout the body as well as limiting the ability of the lung to oxygenate blood.

Numerous drugs are being studied to better control cytokine storm. Thus far there are no definite winners. The public gets their hopes up when drugs like hydroxychloroquine (Plaquenil) get endorsed by non-medical politicians but there are some other medications that are intriguing. As rheumatologists, we have used virtually all of them for the inflammatory diseases that we treat. Corticosteroids are being carefully examined as they are inexpensive and suppress inflammation. Of course the timing is critical. Using drugs that suppress inflammation can allow infection to go unchecked. Thus, drugs that may work on Covid infection such as remdesavir would be more useful in the beginning of a Covid infection and less useful later whereas the cytokine storm inhibitors need to be given at a later time. Currently the 2 drug classes being most intensively studied are interleukin-1 and interleukin-6 inhibitors. Examples of these drugs include Kineret, Ilaris, Actemra and Kevzara. They are approved for use in rheumatoid arthritis. As of this writing, all these medications are considered off label and not covered by insurance for Covid. Double-blind studies suggest that they may work but are certainly not conclusive. Numerous studies are underway in the United States and around the world and we anxiously await the results.

Work on vaccines is moving along rapidly. Historically we have never been able to develop a vaccine as fast as current work is proceeding in this area. Efficacy and safety still need to be established and hopefully this will not be another politicized issue. This is reminiscent of the speed with which ships and fighter airplanes were built in a few days during World War II. (I think of this often when I see the bridges being repaired in Ardmore which take at least 2 years each).

We will get past this. The economic and social impact is already devastating. People are out of work or unable to go to work if they have children unable to go to school. Nothing will be the same, but Main Line Rheumatology and Osteoporosis along with the dedicated health care providers in the Philadelphia area plan to provide the best health care we can offer.

Covid-19 & Your Medications

As we have written previously, it is not clear whether Covid 19 creates additional risk for the biologic medications our patients take for inflammatory diseases.  Most rheumatologists are not telling their patients to stop their medicines unless they have an infection.   This advice has been given for many years.  One unexpected medicine we especially want patients to continue if they are already on it is Plaquenil, (hydroxychloroquine). This drug, used for lupus, Sjogrens and rheumatoid arthritis, is  a cousin of chloroquine. Chloroquine in studies done in China ( for whatever that may be worth) may be beneficial in treating Covid 19. There is not enough data to tell people to take Plaquenil for Covid 19, but if you are on it, talk to us before considering stopping it.

New Hours!

To accommodate our patients, Main Line Rheumatology has increased its hours to better serve you!

Monday 9am – 5:30pm
Tuesday and Wednesday 8am- 4pm
Thursday 9am – 4pm
Friday 8am- 4pm

Tuesday, Wednesday and Friday  9am – 4pm

Lupus and Pregnancy, by Amy Lundholm, DO

Systemic Lupus Erythematosus (SLE)
or Lupus can be associated with gestational hypertension (maternal high blood pressure), preterm birth, intrauterine growth restriction and fetal death. Lupus patients may have abnormal placentation (attachment), which is a major contributor of many pregnancy complications due to reduction in maternal blood flow to the fetus. Despite potential risks, women with SLE can have healthy pregnancies. Women with SLE should have low disease activity for the 6 months prior to conception for the best chance of a successful, healthy pregnancy. The PROMISSE Study was a large multicenter prospective study of pregnant and postpartum SLE patients. The study showed that 26 % of patients had a flare (worsening) during pregnancy, and 24.4% had a flare in the postpartum period. Most of the flares were mild and infrequently required therapy.  Only 6.3% of the patients had severe flares during pregnancy and 1.7% had severe postpartum flares.

Data suggests that the drug, Plaquenil, used during pregnancy was associated with fewer preterm births and less intrauterine growth restriction. Findings also suggest that discontinuation of Plaquenil is associated with higher lupus disease activity during pregnancy.

For SLE patients not looking to conceive, IUDs are considered safe and effective. Other acceptable contraceptive options, when used appropriately, include condoms, progestin (only oral contraceptives) or depo-provera injections. Estrogen-containing contraceptives are contraindicated in the setting of active lupus, as they may flare the disease.

Main Line Rheumatology’s Amy L. Lundholm, DO, is board certified in both rheumatology and internal medicine. Dr. Lundholm holds current membership in the Pennsylvania Osteopathic Medical Association and the American College of Rheumatology. She was chosen as a rheumatology Top Doctor 2018 Main Line Today magazine. To read more about Dr. Lundholm, go to Our Staff.

Main Line Rheumatology Doctors are Coming to the Aid of Workers During the Government Shutdown

The doctors and staff at Main Line Rheumatology (MLR) are coming to the aid of government and furloughed workers who are practice patients currently experiencing a financial strain during the government shutdown. MLR will offer relief from current office co-payments, which can be received from patients at a later date after the government reopens. MLR has office locations at Lankenau Medical Center in Wynnewood, and Main Line Health Center in Broomall. CALL NOW 610-896-8400 for an appointment, and visit