Laurie Cahill first noticed she was having trouble breathing when she climbed stairs. Then one Sunday afternoon, she was having such trouble breathing that she went to the nearby emergency room, where doctors discovered blood oxygen levels were dangerously low. She spent the next 12 days in the hospital undergoing endless tests and biopsies to figure out what was wrong with her lungs. Doctors thought she had congestive heart failure and then they thought she had bronchiolitis obliterans organizing pneumonia (BOOP) but those treatments did not improve her health. She lost weight, became quite weak, and her lung capacity plummeted to 40 percent of normal.
“I was at death’s door,” said Cahill. “My husband did not expect me to live.”
Eventually she made it to National Jewish Health where she saw pulmonologist Gregory Cosgrove, MD, and rheumatologist Aryeh Fischer, MD. Very quickly, Drs. Fischer and Cosgrove recognized that Laurie had polymyositis, an autoimmune rheumatic disease more commonly associated with muscle inflammation than with lung disease. She was shocked and remembers with embarrassment being a bit rude with the doctors who suggested such an unexpected diagnosis. But she had nothing to lose, so agreed to their proposed treatment.
The doctors’ diagnosis and subsequent treatment with an immune suppressant improved Laurie’s lung function, and almost certainly saved her life. Her lung function has risen from 40 percent to more than 70 percent, and she has returned to an active life of cooking, travelling and exercising.
“Dr. Fischer was so involved, checking in on me, calling me at home with the latest test results,” said Cahill. “He’s a rock star!”
Laurie’s case illustrates a point Dr. Fischer has been making in numerous academic publications and at professional conferences around the country.
Rheumatic diseases are too often associated with specific parts of the body — rheumatoid arthritis with joint disease, scleroderma with skin and polymyositis with muscle inflammation, for instance. These diseases, however, are not single organ problems, according to Dr. Fischer. In reality, they are systemic autoimmune diseases that can afflict several organs, especially the lungs. Laurie’s polymyositis manifesting most strongly in the lungs is a perfect example.
Dr. Fischer says that patients with rheumatic diseases often benefit from a multidisciplinary evaluation and management. This approach takes a team effort, a hallmark of care at National Jewish Health. A multidisciplinary team comprehensively evaluates patients, looking not at just one organ or system, but at the whole person. By recognizing that breathing difficulties may actually be caused by rheumatic diseases such as rheumatoid arthritis or scleroderma, they recognize and treat rheumatic diseases that others may miss. As Dr. Fischer emphasizes a more comprehensive approach to patients, he and his colleagues may be redefining rheumatology.
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