Compassionate, ongoing relationships between patients and caring physicians, as well as prompt referrals and advances in technology, have transformed the field of rheumatology in the 22 years Timothy Shaver, MD, FACP, has been in practice.
The changes are clear in his waiting room, which once was filled with patients in wheelchairs exhibiting severe symptoms related to the progression of their rheumatoid conditions.
Today, it’s a different story.
“I’ve seen a trend toward people getting referred much earlier, and that’s kudos in part to the primary care physician population,” Dr. Shaver says. “I think they’re identifying these patients earlier and referring them earlier.”
Dr. Shaver says this makes all the difference in patients’ long-term outcomes.
“It’s been proven that, if you have new-onset rheumatoid arthritis, the intervention of seeing a rheumatologist within the first six to 12 months results in a lower rate of surgery and a higher level of function in that patient,” he says.
Advantages of referrals
“Everybody I see in my office as a new patient I put in one of two categories,” Dr. Shaver says. “They may have something that we simply treat the symptoms, and we may be able to reduce the symptoms and help them feel better.
“There are other conditions which, if we don’t treat them, have the ability to progress and develop complications, and if we can intervene early enough, we can prevent those complications.”
Dr. Shaver says he has three basic goals that apply regardless of category: address and minimize symptoms, prevent damage, and optimize function.
From there, ARCK physicians determine how best to carry out a treatment plan.
ARCK’s Shirley Wang, MD, with Shadi Shahouri, MD (left), and Timothy Shaver, MD, explaining benefits of infusion therapy to a patient.
“We will always communicate back to the primary care physician,” Dr. Shaver says. “If there are recommendations I can give to that physician and feel confident they will take the ball and run with it, then I will give them the suggestions on how to do that. But, if it’s something that requires a more focused effort from a specialist and that’s going to make a difference in how this patient does down the road, then we will stay involved.”
Quality care and quality of life
That involvement is crucial for patients with conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and autoimmune disorders, because of the complexity involved in managing a chronic condition.
Dr. Shahouri, Dr. Wang and Dr. Shaver reviewing advanced features of new ultrasound technology
“We have the time, the expertise and the tools to really focus on the patients’ rheumatic disease, so we can fine-tune the treatment and appropriately monitor the complications, and that can really take the burden away from primary care physicians,” Dr. Shaver says.
Rheumatoid conditions also interact with other bodily systems, increasing risk for cardiovascular disease, diabetes and osteoporosis.
“The No. 1 thing people think of is joint damage and the deformity and disability that can occur, but we’re also starting to appreciate the huge cardiovascular risk when it comes to rheumatoid arthritis,” Dr. Shaver says. “Patients who have rheumatoid arthritis have roughly double the risk of cardiovascular disease as age-match controls and roughly double the mortality of age-match controls.”
He says this risk, similar to that of a diabetic, has more to do with the inflammatory burden of rheumatoid disease than traditional risk factors, but the use of the right therapies to control the disease can reduce mortality rates significantly.
Other conditions, such as osteoarthritis, can be aggravated by both the disease and its treatments.
The Arthritis and Rheumatology Clinics of Kansas expanded this year, with Shirley Wang, MD, heading up the opening of a second location at 801 N. Mur-Len, Suite 112, in Olathe. The new clinic is positioned to meet a need in the Kansas City metropolitan area.
To monitor and minimize the inflammation and impact, ARCK’s Wichita clinic is well-equipped with digital radiography, ultrasound, extremity MRI and a bone densitometry machine.
“What’s driven a lot of these technologies is the availability of biologic therapies,” Dr. Shaver says. “Because the biologic therapies are more costly and also potentially more effective, we need some tools to help in our decision-making process. This can help strategize the aggressiveness of our treatment plan.”
Dr. Shaver cites MRI, which can help predict whether continuation of a treatment will result in further damage. While MRI is more expensive than ultrasound, it can provide an in-depth look at the bony structures involved and costs a fraction of the monthly cost of some therapies.
Dr. Shaver says the intense focus on quality care can pay tremendous dividends for patients’ quality of life.
“We want to make sure we’re optimizing their ability to function, their ability to work, their ability to provide for their families and their ability to do the things they enjoy doing,” he says.
ARCK also has made a name for itself among both patients — who come from all over Kansas, northern Oklahoma and western Missouri — and providers, many of whom spend time at the clinic for their rheumatology rotations.
From left, Stacy Wagner, PA-C; Maya Estephan, MD; Timothy Shaver, MD; Shirley Wang, MD; Shadi Shahouri, MD; Melanie Rohr, MD; and Ruth Busch, APRN
Shadi Shahouri, MD, FACP, and Shirley Wang, MD, FACR, both are known for their compassionate practice and the role they play in further educating the medical community. One of ARCK’s newest physicians, Maya Estephan, MD, was a resident at ARCK.
Dr. Shaver says this is a compliment to the practice.
“I feel positive about the people who have trained here wanting to return here,” he says. “I really believe the reason this has happened is they see how invested we are in treating our patients who have these illnesses and doing so in a quality-conscious and cost-conscious fashion.”
Another new physician at ARCK, Melanie Rohr, MD, wanted to be near her family, so she returned home to Wichita after her training.
ARCK also expanded this year and added a second clinic, under the direction of Dr. Wang, in the Kansas City suburb of Olathe.
For more information about ARCK’s mission, physicians or clinics, please visit arck.org or call 316-612-4815.