Has the Time Come for Wellness Promotion in Rheumatology?

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Despite revolutionary advances in pharmacologic treatments for many rheumatic conditions in recent years, some patients still fail to reach a desired state of living with their disease, notes R. Swamy Venuturupalli, MD, FACR, a clinician and researcher in rheumatology, as well as the founder and director of Attune Health, a Beverly Hills, Calif.-based company that researches treatment for autoimmune and inflammatory diseases.

“As a field, we rely on advances in immune modifiers and biologics to influence our patients’ immune systems,” he says. But a significant proportion of rheuma­tology patients won’t achieve remission. That drives them to explore over-the-counter products, sleep aids, yoga, tai chi, Pilates, acupuncture and a variety of dietary approaches. 

And that’s just scratching the surface, Dr. Venuturupalli says. “Many patients come to us with an interest in non-pharmaceutical, alternative or complementary approaches to managing their disease, some tested and some not.” Or, if they don’t think the rheumatologist will be open to discussing it, they may not even bring it up to the doctor. A lot of non-pharmaceutical approaches come under the broad category of wellness management. And wellness is a booming, patient-driven movement that includes lifestyle changes that could result in alleviating discomfort.

Enter the Rheumatologist

Dr. Venuturupalli

How do rheumatologists fit into this picture? “I often find patients questioning me and wanting my opinion on this approach or that. I have had to educate myself so I can answer their questions more intelligently, beyond the customary response that because it hasn’t been studied enough, we can’t say [anything about it]. Being a trusted source of information for my patients, somebody trained to test medical benefits in an impartial way, I need to give my patients a better answer than that,” Dr. Venuturupalli says.

For Nicole Cotter, MD, a rheumatologist who recently moved her integrative medicine consultation practice from Shreveport, La., to Steamboat Springs, Colo., wellness is the best umbrella term for a variety of approaches to self-management and self-care, including diet, exercise and movement, stress reduction and mind-body medicine—which involves harnessing the mind to control stress and influence overall health and wellness. 

Dr. Cotter was convention­ally trained as a rheumatologist. She pursued a fellowship at the Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, after her patients asked such questions as: What should a person with arthritis be eating? What do you think about the purported benefits of turmeric?

“From the perspective of our training, we really have no [answers]. We usually say there are no data. But is that true?” she asks.