The 16-year-old sits uncomfortably in the car. He slides back his seat, but still feels pain and a bit of swelling in his knees and ankles. "It's just growing pains," his mother says and pats his knee.
The boy shrugs. When dropped off at school, he slowly extracts himself from the car and walks at a snail's pace into the building. His mom watches the boy who used to go everywhere at a run and wonders, "Could something else be wrong with him?" She schedules an appointment for her son, and after seeing the family doctor, the boy is referred to a rheumatologist.
"A lot of young people, children, can get hit with arthritis," says Dr. Susan Barr. She is a rheumatologist. "This isn't just a disease for the elderly."
It's hard to believe that someone so young could be affected by arthritis, but it isn't uncommon. "This crosses the whole age range," says Barr.
Rheumatologists specialize in diagnosing people with rheumatic diseases such as arthritis. They also assist them through treatment and recovery programs. "When these are chronic diseases, we get to know the patients very well," says Barr. "We follow them for long periods of time and develop special relationships with them."
Barr says it's a pleasure to assist people with these diseases, especially when they've been struggling with the disease for some time or have been misdiagnosed. "We have the potential to do a lot of benefit for the person," she says. "There's a lot we can do for people, and that's rewarding."
Rheumatologists specialize in finally figuring out what is ailing someone. "There are about 100 different kinds of arthritis," says Barr. Sometimes it can be difficult to figure out what is affecting a person.
"We have to be detectives in some ways," she says. Once a diagnosis has been made, rheumatologists then have to make careful decisions about treatment.
"We try to pick the best treatment that will minimize the side effects for the patient," she says. "We want to give the treatment that will be the least invasive."
Barr says that treatments for rheumatic diseases have been gaining ground in the past few years. "Some people are difficult to treat," she says. "But we can offer hope. There have been a number of breakthroughs recently and the treatments are changing."
Dr. Michael Maldonado is a rheumatologist in Pennsylvania. He says treatments are getting much better. "New therapies are getting discovered and perfected, and our ability to help people is increasing," he says.
Maldonado says that treatment advances are happening in three different areas. "First, the use of super-aspirins that you see in advertisements are really helping with joint-related pain," he says.
Osteoporosis is a rheumatic disease that causes the bones to weaken and degenerate. "People are managing osteoporosis better," he says. "They're taking more calcium and there is a new class of drugs that can really help."
New drugs can stop bone density loss. They can even restore some of the bone density that has been lost. "When the elderly fall and fracture their hips, that's usually because of osteoporosis," says Maldonado. Other signals that someone might be losing bone mass are height loss and curvature of the spine.
A third medical breakthrough in treatment for rheumatic diseases has to do with autoimmune diseases. "In these diseases, the body's immune system decides to attack its own body," explains Maldonado. He says that these diseases are particularly hard to diagnose because they can have so many different symptoms.
Maldonado is particularly interested in new treatments that can actually stop the body from attacking itself. "We can manipulate the immune system and improve the course of the disease," he explains. "Two new drugs can neutralize an important protein called TNF. This is an important and powerful discovery."
Maldonado says that being able to treat diseases such as lupus, which is often missed or misdiagnosed by physicians, is exciting. Because rheumatologists work closely with their patients, they get to see the results of their efforts.
"I particularly enjoy interacting with people," he says. "You have to see these people often and over a long period of time. You get to see the effectiveness of the treatment, and it makes the work all worthwhile."