We conduct clinical trials on the following therapeutic areas.

Apart from the rheumatology trials, we also conduct some non-rheumatology
trials from time to time. Please contact us for details.

Crohn’s disease (CD) is an inflammatory Bowel disease that causes inflammation in your digestive tract which then leads to severe abdominal pain, diarrhea, fatigue, weight loss and in some cases, malnutrition.

The disease can affect persons of any age, and its onset is most common in the second and third decades. Females are affected slightly more than males, and the risk for disease is higher in some ethnic groups. CD has been characterized by significant morbidity including abdominal pain, diarrhea, weight loss/malnutrition, a progressive nature that leads to complications such as fistulas, strictures, and abscesses.

If you feel that you may have Chron’s Disease and would like more information, please contact us at (480) 626-6650, or by email at trial.info@azarthritis.com

Giant Cell Arteritis (GCA), also known as temporal arteritis, is a systemic vasculitis of the large vessels

with a predilection for the cranial branches of the aorta. GCA affects women to men in a 3:1 ratio and

almost exclusively those over age 50. Giant Cell Arteritis is characterized by a relatively abrupt onset

followed by chronic vascular and systemic inflammation. Those with Giant Cell Arteritis may experiences such as reoccurring headaches, jaw paid, and ocular symptoms such as vision loss. Systematic symptoms include fever, fatigue and weight loss.

Physicians diagnose gout when they see someone who has the classic presentation of intermittent flares of their joints in the setting of high blood uric acid. Although the blood uric acid is not always elevated during an acute flare it is almost always elevated between flares. A definitive diagnosis can be made when fluid is aspirated from the joint and it shows the colorful needle-shaped crystals of uric acid.

Treatment of gout involves two different approaches:

1.Treating the inflammation

2.Preventing flares by lowering the uric acid.

Treating flares of gout can be done with nonsteroidal anti-inflammatory agents, colchicine, and corticosteroids. Treatment of flares usually works best if started as soon as possible after an attack begins. Gout can be prevented with medications like allopurinol, febuxostat, and probenecid. These medications lower uric acid quickly but it will usually take months to completely prevent flares. Restricting foods high in purine is also important in controlling blood levels of uric acid. These include foods like seafood, organ meat and beer.

Although gout can be an extremely painful disease it also is one of the most treatable diseases. With careful attention to diet and strict compliance to medications most patients can lead normal active lives.

At Arizona Arthritis and Rheumatology Associates we help patients control their gout with dietary and medical management. Our research arm of the practice Arizona Arthritis and Rheumatology Research (AARR) helps develop new medications to advance the treatment and prevention of gout.

By: Dr. Eric Peters, M.D., Rheumatologist

Lupus Nephritis (LN) is an inflammation of the kidneys in individuals who have lupus or systemic lupus erythematosus (SLE).
Signs of Lupus Nephritis are often present at the time of the diagnosis of lupus. Kidney problems commonly develop during the course of the disease.
If not diagnosed and treated early enough, Lupus Nephritis can lead to significant illness. The implications of LN without treatment can be severe. It is vital that kidney function is preserved and maintained with a strict and regular regime of treatment. Signs of Lupus Nephritis include, but are not limited to Blood in the urine, High blood pressure, and swelling in your hands, feet and ankles.

Sjogren’s Syndrome (SjS) is estimated to affect approximately 1% of the population worldwide

{Patel 2014}; it is a systemic autoimmune disease that is primarily diagnosed in women 40 to

60 years of age, but can occur at any age. About half of all patients with SjS also have another

concurrent autoimmune disease, most often, RA or SLE. Those with Sjogren’s Syndrome may experience dry eyes, dry mouth and general fatigue. Those with Sjogren’s Syndrome also suffer from Cognitive difficulties which may lead to difficulty performing every day tasks. Sjogren’s Syndrome may oftentimes go undiagnosed unless they are suffering from another autoimmune disease that they are receiving care for.

Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disease which affects up to 0.8% of the population which translates into 2.4 million Americans. It’s cause is due to genetic susceptibility and environmental factors which research is beginning to identify. It causes joint pain, stiffness, patterned symmetrical joint swelling of the fingers and wrists (being most common), deformities, X-ray damage, decreased function, poor quality of life and disability. RA contributes to other disease states such as heart attacks and strokes. The diagnosis is made on the symptoms, examination, blood tests known as rheumatoid factor and anti-CCP antibody, X-rays, ultrasound, and MRI.

Cortisone (e.g. prednisone) and NSAIDs e.g. ibuprofen, naproxen can help symptoms but do not have the ability to modify the joint destruction and functional decline. They may cause stomach bleeding, poor kidney function, high blood pressure and cardiovascular side effects among other side effects.

Disease modifying anti-rheumatic drugs (DMARDs) have the capacity to drive the disease to a low activity state. The gold standard methotrexate at 15-25 mg per week, Arava, sulfasalazine, and the less potent Plaquenil are examples. But they often fail to induce remission. Newer biologic agents especially when used with methotrexate can affect good clinical outcomes. They include Enbrel, Remicade, Humira, Orencia, Rituxan, Cimzia, Simponi, and Actemra (listed in the order of approval by the FDA). However, even on these agents most RA patients do not achieve remission and they also may cause mild and serious side effect which limit their use. More research is needed to refine treatments with these agents and to identify new more effective, safe and less expensive drugs to help patients with RA. Only when RA patients volunteer for clinical research trials are better therapies discovered.

The physicians in practice at Arizona Arthritis & Rheumatology Associates and their research division Arizona Arthritis & Rheumatology Research are dedicated to the care of patients with RA. They helped develop the available RA therapies and are investigating new drugs on the horizon. We encourage patients with RA to contact us to participate in our growing research efforts and to become patients of our cutting edge rheumatology center.

By: Dr. John Tesser, M.D., Rheumatologist

Osteoarthritis, not surprisingly, is referred to as the “wear and tear” type of arthritis since it will likely occur in all of us who tread long enough on this planet with gravity or who have had repeated injury or stress on our joints. This idea also helps conceptually to distinguish osteoarthritis from inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and lupus arthritis, to mention a few. Cartilage is a substance (you’ve seen that pearly smooth material on the ends of chicken bones) that protects our bones where they connect with each other to make a movable joint. As the structure of cartilage fails, stresses are transferred directly to bone. The silky smooth joint interface is then lost. The bone responds to more direct stress by thickening and at some point the joint begins to hurt.

Although the concept is useful, it is a bit of an oversimplification, since there is a strong genetic component to osteoarthritis that is revealed in the big differences among individuals and families in the rate of degeneration of protective cartilage in our joints over the years. While there is no question that obesity is a risk factor for advancing osteoarthritis particularly in the hips, knees and lower back, we sometimes see lightweight, dainty ladies who have probably never broken a real sweat come in with end-stage osteoarthritis requiring joint replacement to maintain the ability to walk. There is a familial type of osteoarthritis that occurs commonly in the small joints of the fingers that is genetically programmed to progress regardless of hand activity.

Medical science understands a lot about the mechanism of cartilage metabolism and degeneration, but hasn’t yet discovered a way to stop the degenerative process or to make us re-grow new “original equipment” cartilage. Despite the genetic observations, management of osteoarthritis begins with prevention, or as we call it, joint protection. Wearing proper supportive foot wear as well as all the available protective gear for sports and work, using proper body mechanics with lifting, maintaining normal body weight and avoiding carelessness that results in joint injury all make a difference.

Many modalities are in medical use to help people deal with the symptoms of osteoarthritis and to remain active. These include exercise and strength maintenance, pain medications, joint injections of corticosteroids or biological lubricants, supportive devices for joints and walking aids. Arizona Arthritis and Rheumatology Associates participate regularly in clinical trials of new medications or devices for osteoarthritis and people are encouraged to consider these studies among the available options. Surgical interventions by orthopedists including arthroscopy or joint replacement are appropriate for some folks with osteoarthritis.

By: Dr. Paul Caldron, D.O., Rheumatologist

A patient presented to my office as a new patient, sent because of elbow pain. After careful history taking and an examination of the elbow, it was determined that she had what is better known as “Tennis elbow”, or lateral epicondylitis. Further examination, revealed what we call dactylitis (sausage digit, because it looks like a sausage), pitting of a couple of finger nails and some psoriasis in the Umbilicus (belly button). The diagnosis then went from a localized/isolated tennis elbow to a diagnosis of Psoriatic arthritis.

Psoriatic arthritis comes in many forms and varieties. It can look just like rheumatoid arthritis (RA), involve the spine in a way similar to ankylosing spondylitis (inflammation of the spine), and can be associated with non-musculoskeletal issues such as sores in the mouth and inflammation in the eye. Of course, it is also possible to have Rheumatoid Arthritis in combination with, but unrelated to psoriasis. It is an excellent example of how the pattern of joint involvement can be a clue to the correct diagnosis, and of how the precise diagnosis can be elusive, but is usually more straight forward in the hands of an experienced physician who knows what questions to ask and takes the time to do a thorough exam. Psoriatic skin/nail changes, may predate the joint symptoms, or even follow the joint symptoms by years.
X-rays and labs can assist in the diagnosis, but can be as confusing to the “uninitiated/inexperienced” observer as they can be helpful. Psoriatic arthritis is, as are most illnesses, diagnosed primarily with a good history, good physical exam, and experience helps. The lab and x-rays are only ancillary. Just because a patient has a positive Rheumatoid factor, does not mean that they have RA and not psoriatic arthritis.

Patients have chronic illness, characterized by periods of relative improvement and then periods of flare-ups i.e., worsening. Our aim is to control the numbers of flares, the severity of the baseline level of inflammation, discomfort and disability, and to lessen the severity and the duration of flares. Ultimately, we aim to place the problem into prolonged remission
with drugs such as Methotrexate, and other DMARD (Disease Modifying Anti-rheumatic Drugs) and/or the Biologic modifiers, such as Remicade, Humira, Enbrel, just to mention a few. Because of potential side-effects, we tend to use less often, the class of drugs known as Non-steroidal anti-inflammatory drugs (NSAIDs). Since I had started in practice, the treatment has improved by leaps and bounds.

From time to time, we, at AARA PC might have a research protocol or two aimed at psoriatic arthritis, and it wouldn’t hurt to periodically call us and check up on this if one has been diagnosed as having Psoriatic Arthritis. We also have ongoing research studies for RA, and OA and other varieties of Rheumatic disease.

 

By: Dr. John Starr, M.D., Rheumatologist