Frequently Asked Questions

Rheumatology is a medical specialty focused on the diagnosis and treatment of autoimmune, inflammatory, and mechanical diseases affecting joints, bones, muscles, and connective tissues.

If you're experiencing unexplained joint pain or swelling, chronic fatigue, unexplained rashes, frequent mouth ulcers, hair loss, or signs of systemic inflammation in lab testing, you should see a rheumatologist.

Diagnosis involves a combination of medical history, physical examination, laboratory tests, and imaging studies like X-ray and ultrasound. Rheumatologists may also extract fluid from joints (arthrocentesis) to clarify a diagnosis.

While some conditions can go into remission with treatment, most rheumatic diseases are chronic and require ongoing care. Cure isn't always possible, but quality of life can often be significantly improved with modern treatment approaches.

Yes. Maintaining a healthy weight, regular exercise, and following an anti-inflammatory diet can play a meaningful role in managing symptoms alongside medical treatment.

Yes. Rheumatologists can help manage symptoms associated with long COVID, including chronic fatigue, brain fog, and muscle pain.

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and tenderness — often without a clear structural explanation. It frequently co-occurs with migraines, cognitive difficulties ("brain fog"), tingling or numbness, gastrointestinal changes, and mood disorders.

The exact cause isn't fully understood, but it likely arises from a combination of genetic, environmental, and psychological factors. Physical or psychological trauma, poor sleep, chronic illness, and genetic predisposition may all contribute.

There are no reliable lab tests or imaging studies for fibromyalgia. Diagnosis is based on a thorough medical history, physical exam, occasionally testing to rule out related conditions, and the presence of widespread pain lasting at least three months.

Absolutely. The pain of fibromyalgia is invisible — nothing shows externally — which makes it difficult for others to understand how debilitating the symptoms can be. Modern research confirms observable molecular-level changes through specialized imaging. It is a real neurological condition involving abnormal pain processing in the central nervous system.

Treatment typically involves a multidisciplinary approach: medications (pain relievers, neurologic medications), addressing contributing factors like insomnia, plus lifestyle changes, exercise, physical therapy, and stress management.

Biologics target specific molecules in the immune system — such as cytokines or immune cells — to reduce inflammation and modify the underlying disease process. They aim to restore immune balance in conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Biologics are given either as subcutaneous injections (self-administered at home) or intravenous infusions (administered in our on-site infusion center by an RN). The method depends on the specific medication and your condition.

When used appropriately, yes. Because biologics target a single molecule rather than broadly affecting the body, side effects tend to be less frequent than with traditional immunosuppressants. Common side effects include mild injection site reactions and slightly increased infection risk. Serious side effects are uncommon.

It varies. Some patients notice improvement within weeks; for others, it may take several months. Your rheumatologist will monitor your response and adjust treatment as needed.

Safety varies by medication. Some biologics are considered fully pregnancy-compatible. Discuss your specific situation with your rheumatologist — planning ahead is important.

Decisions about stopping or tapering biologics should always be made with your rheumatologist. Some patients achieve remission and can discontinue treatment; others need ongoing therapy to maintain disease control.

Infusion therapy delivers medication directly into your bloodstream through an IV line. In rheumatology, this includes biologics like infliximab (Remicade), Actemra, Orencia, and others that are most effective when given intravenously.

Sessions typically range from 45 minutes to several hours depending on the medication. Your first infusion of a new medication usually takes longer due to monitoring protocols.

You'll sit in a comfortable recliner in our on-site infusion center. A registered nurse administers and monitors your infusion throughout. You can eat, drink, read, work on a laptop, or relax. Dr. Fellows is on-site if any questions arise during your treatment.

Yes, in most cases. We encourage you to bring snacks, water, and anything that makes you comfortable. Your nurse will let you know if your specific medication has any restrictions.

Most patients drive themselves without issue. If it's your first infusion of a new medication, you may want to arrange a ride as a precaution until you know how you respond.

Most insurance plans cover infusions when prescribed for approved indications. Medicare Part B covers 80% of infusion costs, and Medigap plans often cover the remaining 20% — meaning many Medicare patients have little to no out-of-pocket cost for infusions.

Older, established medications like methotrexate, sulfasalazine, and azathioprine are generally covered well by commercial insurers at lower copay tiers. If your pharmacy is charging more than expected, ask your physician — there may be better options.

Yes. Many medications can be obtained at significantly lower cost by paying cash and bypassing insurance entirely. Mail-order pharmacies like Cost Plus Drugs sell medications at wholesale cost with transparent markup, often for far less than insurance copays for the same drug.

Commercial insurers often cover biologics but at unrealistic copay levels ($600–$2,000/month). Nearly all biologic manufacturers offer free copay assistance programs that reduce out-of-pocket costs dramatically — usually to $5–$10 per month. We strongly recommend enrolling in these programs at the time of prescription.

Infusion therapies are covered well under Medicare Part B — 80% of the cost is covered without question for approved indications. Medigap (supplement) plans often cover the remaining 20%, leaving patients with little to no out-of-pocket cost after their Part B deductible. For this reason, infusion therapies are often the preferred option for Medicare patients.

At-home injectable biologics under Part D vary by plan. Copay assistance programs from manufacturers are not available for Medicare patients, so copays can be high. Check with your specific plan for details.

Coverage under Advantage plans is often poor. While plans may technically "cover" a biologic, they frequently impose monthly copays of $600–$1,000 or more. For this and other reasons, many physicians generally do not recommend Advantage plans for patients who require specialty medications.

PBMs manage an insurer's list of covered medications by negotiating prices with manufacturers. Today, most PBMs are owned by the same parent companies as the insurers themselves — for example, United Healthcare owns OptumRx, CVS owns Caremark, and Cigna owns Express Scripts. This consolidation allows insurers to steer patients toward their own pharmacies.

A copay accumulator is a rule within some insurance plans that prevents manufacturer copay assistance from counting toward your annual deductible. The result: the insurer exhausts your copay assistance early in the year, then you're suddenly responsible for large monthly copays — often exceeding $1,000 — until your deductible is met. These programs are anti-consumer and have been banned in many states, but remain legal in California. If your copay assistance is suddenly exhausted, call our office — there are usually solutions.