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Our evidence-based, empathetic approach to autoimmune rheumatology care and treatment

What are Pros and Cons of Rheumatology Appointments via Telehealth?

When you're looking for or considering a new rheumatology practice to help your symptoms and create a new treatment plan, it may feel like a given that an in-person appointment is mandatory. And I understand that, as an autoimmune rheumatology patient myself, first diagnosed 14 years ago. However, through the years of my practice and as a patient, I see great benefits to a telehealth practice -- if I felt I wasn't able to diagnose you, or treat your symptoms as well or better than an in-person appointment, I would not practice medicine this way. Rheumission has adopted a virtual-first approach to treating rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We believe that our telehealth model improves accessibility, convenience, and better serves our patients overall. Below I’ll take you through the three reasons why.

How does a virtual rheumatology care team work for you?

As you go through your patient journey, there’s one key element that becomes clear: finding the right, supportive rheumatologist and overall healthcare team is the most important part of life as a person with a chronic condition.

The right doctor and team help keep you on a successful path to sustained remission – feeling good, positive and hopeful each day about the symptoms that touch most aspects of your life and the treatment to heal them.

When you're looking for or considering a new rheumatology practice, it may feel like a given that an in-person appointment is mandatory. And I understand that, as an autoimmune rheumatology patient myself, first diagnosed 14 years ago.

However, through the years of my practice and as a patient, I see great benefits to a telehealth practice -- if I felt I wasn't able to diagnose you, or treat your symptoms as well or better than an in-person appointment, I would not practice medicine this way.

Rheumission has adopted a virtual-first approach to treating rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We believe that our telehealth model improves accessibility, convenience, and better serves our patients overall. Below I’ll take you through the three reasons why.

Why is a virtual visit as good as an in-person visit?

A virtual rheumatology visit can be just as good as an in-person visit because, in both scenarios, the patient’s clinical history, labs, and imaging often inform the diagnosis.

Sometimes, swelling can be subtle and hard to visualize through a virtual exam. In these cases, the patient would be referred out for imaging. This is not dissimilar to in-person visits - rheumatologists often order imaging to fully visualize joint swelling before confirming a diagnosis.

An in-person visit does allow me to press on joints and do needle injections and aspirations. If injections are needed for virtual patients, you may be referred to local clinics who can perform the test and then send me the results that we can review together.

How can I ensure that my diagnosis will be the same as if I saw you in-person?

A rheumatology diagnosis relies most heavily on the patient’s clinical history, labs, and imaging. However, there are some cases where parts of the physical exam are unclear, and the patient’s history, labs, and imaging do not provide enough information. In these few cases, a referral to an in-person rheumatologist may be needed.

In all rheumatology visits, it’s important that I can focus on you, and listen closely to your history. Some in-person doctors barely examine patients or look at them during a visit.

Communication does not need to be rushed during a telehealth visit, and communication styles are often very individual to the provider. At Rheumission, our initial visits are one hour long, and follow-up visits run for 30 minutes. This is an uncommonly high amount of time for medical appointments, but we understand and value deeply listening to our patients and their history, before jumping into treatment decisions.

What are some benefits of virtual care?

Virtual care increases accessibility and decreases wait times before appointments. If there’s a case where you need an in-person exam, you can start and continue on with virtual appointments rather than waiting months for any sort of care.

As an autoimmune patient myself, I know that a lot of autoimmune patients struggle with brain fog and keeping track of their appointments. One benefit of virtual care is that it’s easier to jump into a visit or make up a visit after the fact. For example, say you forgot about your appointment and went to the beach. You remembered that you had an appointment once you got there, but you could still complete the exam outside of your home. Virtual visits can be completed anywhere at the convenience of the patient. If this were an in-person visit, it would be much more difficult to make up the visit if forgotten.

A common issue with our world’s shift towards more remote/virtual models is a general decrease in physical activity. In the case of virtual appointments, you lose the walk to and from the clinic.

This would be a loss for a conventional telehealth practice that does not include movement as a part of its treatment approach. However, here at Rheumission, we’ve adopted an integrative, lifestyle approach where we encourage patients to incorporate more movement into their routine as part of every treatment plan.

So what's the most important thing to know about telehealth rheumatology visits?

Remote rheumatology visits are comparable to in-person appointments, with increased availability, convenience, and unrushed time for deeper conversations about your health.

While remote models are still relatively new, we believe that the increased accessibility and coordination of care within a telehealth practice is the best way forward for rheumatology patients, which is why we set up Rheumission – so that we can give you the best care possible.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with our co-founder, Dr. Bonnie Feldman. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

What is Lifestyle Medicine and How Will It Work for Me and My Treatment?

In recent years, the fields of lifestyle medicine, integrative medicine and functional medicine have gained attention for their holistic approaches to health and wellness. Here at Rheumission, we aim to combine the best tools and levers from integrative, functional and conventional medicine to help our patients reach remission. But what exactly is lifestyle medicine? It’s an important new field of medicine that is helpful to understand both how it differs from other fields of medicine, and how it fits into the broader picture of managing conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

Living with an autoimmune condition can feel like navigating a complex maze of doctors appointments, various treatments and expensive medications.

Many people with autoimmune arthritis, which we treat, find themselves searching for relief from years of pain and suffering. We understand this at Rheumission, since our method was developed by autoimmune patient-doctors.

In recent years, the fields of lifestyle medicine, integrative medicine and functional medicine have gained attention for their holistic approaches to health and wellness.

Here at Rheumission, we aim to combine the best tools and levers from integrative, functional and conventional medicine to help our patients reach remission.

But what exactly is lifestyle medicine? It’s an important new field of medicine that is helpful to understand both how it differs from other fields of medicine, and how it fits into the broader picture of managing conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

What is lifestyle medicine and how will it help me?

The American College of Lifestyle Medicine defines lifestyle medicine as a “medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions.”

In other words, as lifestyle medicine certified clinicians, we take a holistic approach and treat our patients first with evidence-based and prescriptive lifestyle change.

We still use medications when needed, but our aim is to utilize the 6 pillars of lifestyle medicine to treat, prevent and even reverse disease:

Whole food plant-based nutrition
Physical activity
Stress management
Restorative sleep
Avoidance of risky substances
Positive social connections

Lifestyle medicine is about empowering you to take an active role in your health in a new way, by supporting you with the tools necessary to improve not only your health, but also your quality of life!

In lifestyle medicine, we often ask patients, “What is your why?” In other words, what gets you up in the mornings? What motivates you? Why do you want to improve your health?

From my experience working in primary care and lifestyle medicine, some examples of a patient’s “why” may be to see their grandchildren graduate from college, to travel to new and exciting places or to be there for their children as they grow up.

Usually it boils down to wanting more quality time with loved ones, traveling to see new places, or feeling fulfilled in one’s purpose in life. Once a patient connects with their deeper why, they are often more motivated to make the necessary changes for improved health and happiness.

How will you use lifestyle medicine to help me with my autoimmune arthritis?

The pillars of lifestyle medicine encompass various aspects of daily life that profoundly impact health outcomes:

Nutrition: Scientific evidence strongly supports the use of whole-food, plant-predominant food choices for preventing and treating chronic disease.
1. This diet is rich in fiber, antioxidants and essential nutrients found in minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds.
2. For people with autoimmune conditions, this is particularly important because a whole-food plant-based diet has been proven to be anti-inflammatory.
3. Aim for half of your plate to be green leafy vegetables or non starchy vegetables, a quarter of the plate be protein - ideally a plant protein like legumes - and a quarter of the plate be whole grains or starchy vegetables.

Physical Activity: Regular exercise is essential for maintaining joint mobility, muscle strength, and overall physical function.
1. Low-impact activities like walking, swimming, yoga, and tai chi can be particularly beneficial for individuals with autoimmune arthritis, helping to manage pain and stiffness while improving cardiovascular health.
2. Find a form of movement that brings you joy, and aim to do it on a regular basis.
Stress Management: Chronic stress can exacerbate inflammation and contribute to symptom flare-ups in rheumatic diseases.
1. Techniques such as mindfulness meditation, deep breathing exercises, prayer, positive self-talk, progressive muscle relaxation, and cognitive-behavioral therapy can help individuals better cope with stress and improve their overall well-being.
2. Find a mindfulness practice that you enjoy and aim to do it for at least 3 - 5 min per day.
Restorative Sleep: Adequate sleep is crucial for immune function, tissue repair, and overall health. Poor sleep quality or sleep disturbances are common in patients with autoimmune arthritis.
1. Lack of sleep triggers the sympathetic nervous system to release fight or flight neurotransmitters, impairs our gut microbiome and interferes with normal hormone balance and function.
2. All of these factors play a role in triggering an increase in pro-inflammatory particles which can worsen autoimmune symptoms and disease.
3. Establishing healthy sleep habits and addressing sleep disorders can significantly improve health outcomes and can reduce chronic pain.
4. Try to optimize your sleep environment and aim for 7 hours of sleep each night.
Positive Social Connections: Strong social connections and a supportive network of friends, family, and peers play a vital role in our physical, mental and emotional health.
1. Engaging in meaningful social activities, joining support groups, and fostering positive relationships can provide emotional support and enhance overall well-being.
2. Aim to have one positive and meaningful connection each week.
Avoidance of Risky Substances: Engaging in tobacco use and alcohol consumption have been linked to higher risks of chronic diseases and mortality.
1. Treating these habits typically requires multiple approaches and attempts over time.
2. Be patient with yourself and seek help from your clinicians and your support system.

How is lifestyle medicine different from my primary care doctor?

At Rheumission, our lifestyle medicine clinicians have a background in primary care with additional training in lifestyle medicine. This additional training includes an emphasis on the lifestyle interventions described above.

When you meet with our lifestyle medicine clinicians, they will focus on how the pillars of lifestyle medicine are affecting your chronic conditions, and will partner with you to make sustainable lifestyle changes.

We encourage our patients to continue to see their primary care physician as the Rheumission team – including your integrative rheumatologist, lifestyle medicine clinicians, and autoimmune registered dietitian – will be partnering, and coordinating with your primary care provider in some instances, for your care. You can think of your Rheumission team as an additional team-based specialty that you are seeing.

How does lifestyle medicine differ from integrative or functional medicine?

While lifestyle medicine, functional medicine and integrative medicine all share common goals of promoting health and wellness, each approach has its unique focus and methodologies.

Lifestyle medicine has its distinct emphasis on promoting healthy behaviors and lifestyle modifications to prevent and manage chronic diseases.

It recognizes that many chronic conditions, including autoimmune diseases, are influenced by lifestyle factors such as diet, physical activity, stress management, sleep quality, and social connections. Lifestyle medicine encourages individuals to adopt sustainable lifestyle changes that support their overall health and well-being.

Integrative medicine emphasizes the integration of conventional medical treatments with complementary and alternative therapies. It acknowledges the importance of addressing the physical, psychological, social, and spiritual aspects of health to achieve optimal well-being. In the context of autoimmune conditions, an integrative rheumatologist may combine conventional medications with interventions such as massage therapy, or mind-body practices, to manage symptoms and improve quality of life.

Functional medicine investigates the underlying root causes of disease by examining the interactions among genetic, environmental, and lifestyle factors. Practitioners of functional medicine take a systems-oriented approach, considering the interconnectedness of various bodily functions and how imbalances in one area can affect others. For individuals with autoimmune conditions, a functional medicine provider may focus on identifying triggers such as dietary factors, gut health issues, or environmental toxins that contribute to inflammation and symptom flare-ups.

At Rheumission, our two Medical Directors, Dr. Micah Yu, MD, and Dr. Melissa Mondala, MD, are both trained in the conventional medical model and in lifestyle medicine, integrative medicine and functional medicine.

What is lifestyle medicine's role in the Rheumission Way?

Our lifestyle medicine clinicians work closely with the integrative rheumatologist, registered dietitian and autoimmune psychologist. We have a strong, interdisciplinary care team that works together and with you, our patient, to provide holistic, personalized ongoing care with the goal of sustained remission.

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with our co-founder, Dr. Bonnie Feldman. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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Want to learn more about the integrative rheumatology pillar of Rheumission? Read our founding Integrative Rheumatology Director Dr. Micah Yu's post about how and why telehealth rheumatology appointments are just as good or better than in-person appointments for easier access and greater convenience, while offering an assessment of symptoms and treatment options that are the same as going in-person.

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About the Author

Christina Lascano, MPAS, DipACLM, PA-C, is a highly skilled, board-certified Physician Assistant with additional board certification in Lifestyle Medicine from the American College of Lifestyle Medicine. Christina graduated from the University of North Texas Health Science Center in 2017, earning a Masters of Physician Assistant Studies. She also holds a Bachelor of Science in Allied Health from Texas A&M University, which she completed in 2014. With over seven years of dedicated experience as a PA, Christina is committed to empowering her patients through personalized and prescriptive lifestyle interventions, striving to enhance their health and overall quality of life.

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Thought Leadership and New Ideas

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