Beyond the Clinic: Lessons Learned from a Rheumatologist with RA

Dr. Singla

Saimun Singla, DO, a pediatric rheumatologist and owner of Rheum to Grow in Houston, can empathize when her young patients discuss the challenges of managing stiff and painful joints.

Board-certified in general pediatrics and pediatric rheumatology, and fellowship-trained in integrative medicine, Dr. Singla’s knowledge of rheumatic diseases goes far beyond what she learned in her formal education. While working as an attending physician at Texas Children’s Hospital, Houston, Dr. Singla was diagnosed with rheumatoid arthritis (RA).

The Journey Begins

“Shortly after giving birth to my second child, who is now 7, I started experiencing fatigue, stiffness and pain in my fingers,” Dr. Singla says. “While I knew women have a higher rate of developing autoimmune disease after a pregnancy, I initially chalked my symptoms up to having a toddler, a new baby and a busy medical practice.”

Over time, Dr. Singla noticed her symptoms were becoming worse, and she reached out to a colleague who specialized in adult rheumatol- ogy asking for a consult.

“I told her it was probably nothing, but she insisted I come in during her lunch break,” Dr. Singla says. “After conducting an exam, she diagnosed me with inflammatory RA, which wasn’t the diagnosis I had anticipated. I was shocked.”

Dr. Singla was initially prescribed hydroxychloroquine (Plaquenil) and a short course of corticosteroids, but she continued to experience stiff- ness. After a few months, her rheumatologist added adalimumab (Humira) to her treatment regimen.

Then Dr. Singla experienced an allergic reaction to adalimumab. “I woke up one morning with swollen lips and eyes the day after my injec- tion,” she says. “I tried several different biologic medications after that, and I’m currently taking a combination of Cimzia [certolizumab pegol] and methotrexate injections.”

Introducing Integrative Care

After years of trying and exhausting different medication options, Dr. Singla realized she was both living and practicing medicine in a sick care model of healthcare focused exclusively on disease management.

“As physicians, we’re trained to focus on the biology and treatment of disease,” Dr. Singla says. “This is, and should be, the heart of our medical training, but blind focus on this aspect of medicine misses other variables that contribute to disease. Until I was diagnosed with RA, I never realized how much such factors as sleep, diet and stress contribute to arthritis flares.”

At the time, Dr. Singla was also fielding questions from families about how they could help their children live better lives that went beyond non-steroidal anti- inflammatory drugs (NSAIDs), corticosteroids, biologics and disease-modifying anti-rheumatic medications (DMARDs).