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.

Latest News on How Plant Based Diets Can Help People with Rheumatoid Arthritis

Rheumatoid arthritis — a chronic autoimmune condition that causes pain and stiffness in the joints affects between 0.3% and 1% of the world’s population, according to the World Health Organization (WHO). Now, a new review appearing in the journal Frontiers in Nutrition shows that following a plant based diet can be a useful intervention when it comes to coping with this condition, as it triggers some helpful biological changes, stating, “Symptoms may improve or even disappear.”


It’s Important to Get The Right Diagnosis and Care for Painful Autoimmune Conditions

Many rheumatologic diseases are difficult to sort out in the beginning. New York Times medical writer, Jane Brody, describes polymyalgia, an inflammatory disease affecting muscles and connective tissue in the shoulder/pelvic region, and the overlapping and more serious temporal or giant cell arteritis, involving blood vessels to the scalp and the eyes with potential risk of blindness. Talk to your primary care physician and consider seeing a rheumatologist if you have these symptoms.



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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

Main Line Rheumatology Welcomes New Staff Rheumatologist, Hyon Ju Park, MD

Philadelphia, PA May 9, 2019… Main Line Rheumatology is excited to announce that we have added Hyon Ju Park, MD, to our staff of rheumatologists. Dr. Park has an impressive resume. She is board-certified in rheumatology and internal medicine, and certified in clinical densitometry (bone density studies).  Dr. Park graduated Columbia University in 2003 with a degree in biochemistry, and graduated Mount Sinai School of Medicine in New York, in 2007. She completed a residency in Internal Medicine at Barnes Jewish Hospital in St. Louis, Missouri as well as a rheumatology fellowship and additional research fellowship at Washington University in St. Louis, Missouri.

Dr. Park has been an avid contributor to medical publishing including editorials, reviews, case reports and many book chapters. She has a special interest in lupus, vasculitis, and periodic fever syndromes.

Dr. Park is the mother of two children, and her husband is a cancer researcher at the University of Pennsylvania.

Men Get Osteoporosis, Too!

Main Line Rheumatology sees many patients with osteoporosis. At least 95% are women, yet statistics looking at people over age 65, find the ratio closer to 50%. Why is that? Most women see their gynecologist for a yearly exam, and those doctors are very good about ordering DEXA (bone density) scans. There is no equivalent for men! Perhaps primary care physicians and urologists should be cautioned that men are at risk for osteoporosis as their testosterone levels fall, just the same as estrogen plummets in women after menopause. Read this informative column by Jane E. Brodey, Personal Health columunist for the New York Times, since 1976.


Philadelphia TOP DOCTORS 2019 Winners and Still Champions! 

CONGRATULATIONS! Philadelphia magazine awards Gary V. Gordon, MD, FACP, FACR and Thomas Harder, MD, Main Line Rheumatology, TOP DOCTORS 2019!

Main Line Rheumatology has offices at Lankenau Medical Center and Main Line Health Center, in Broomall. In addition to Dr. Gordon and Dr. Harder, our doctors, Amy Lundholm D.O. and Hyon Ju Park, MD, are both board certified in rheumatology and internal medicine. Call 610-896-8400 for an appointment. Follow us on Facebook, Instagram and Twitter.

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