Dr. Cotter
“When we talk about integrative medicine, we are just describing good medicine,” says Dr. Cotter. “We have separated the body from the mind, but they are connected.”
When rheumatologists say these kinds of wellness approaches aren’t part of their jobs, it may come from lack of knowledge about non-pharmaceutical approaches or a lack of time. “But if we are the doctors of inflammatory conditions, it is part of our job, because lifestyle affects inflammation,” says Dr. Cotter.
A Time for Wellness
Leonard Calabrese, DO, believes the time has come for incorporating wellness strategies routinely into rheumatology practices and to stop treating them as alternatives to conventional medicine.
“I believe there has been an underemphasis and a lack of resources invested in encouraging wellness behaviors for patients with rheumatologic conditions,” says Dr. Calabrese, a professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He also holds the R.J. Fasenmyer Chair of Clinical Immunology and the Theodore F. Classen, DO, Chair of Osteopathic Research and Education, and serves as vice chair of the Department of Rheumatic and Immunologic Diseases at the Cleveland Clinic.
Dr. Calabrese
In the past 20 years, incredible progress has been made in the development of targeted therapies for many rheumatic conditions, according to Dr. Calabrese. And the science of well-being has simultaneously advanced. Patients with rheumatic diseases of all sorts have their own goals, which don’t always overlap with what the rheumatologist offers. “We focus on joint damage, skin clearance or inflammatory markers, but our patients are more interested in addressing their pain, fatigue and generalized well-being—in other words, their lived condition.”
Wellness strategies address the physical, mental and spiritual dimensions of the human being, he says. “I believe in taking care of the whole patient and looking for ways to care for them that will be the most effective. When I talk about this with rheumatologists, often they are astounded to discover how much data there actually are to support various wellness approaches.”
What, then, is the roadblock keeping rheumatologists from going all in with wellness strategies for their patients? Most rheumatologists aren’t yet sold on wellness science, Dr. Calabrese says. There is a gap in knowledge. Even when they are familiar with the benefits of a healthy diet or sleep hygiene, they lack confidence in their own ability to engage in such conversations with their patients.
‘When we talk about integrative medicine, we are just describing good medicine,’ says Dr. Cotter.
He is involved with initiatives to compile the data and make it more accessible for both patients and providers. The Cleveland Clinic is building a comprehensive online program of wellness behavioral training, called Immune Strength. The program is now in beta testing for usability and acceptance, starting with patients who have psoriasis, psoriatic arthritis and spondyloarthritis before moving on to other immune-modulated diseases.
The goal is to create an evidence-based online program available to all, one that complements aggressive, targeted therapy of immunologic diseases, Dr. Calabrese says, adding that the immune-strengthening message seems to be resonating with a wide audience in the COVID-19 era, not just those with active immune diseases.
What Wellness Includes
What does wellness-oriented self-management encompass for rheumatology patients and for their physicians?
Diet
Many foods are known to be inflammatory and may contribute to the development of inflammation.
A balanced Mediterranean diet, emphasizing the traditional flavors and cooking methods of southern European countries bordering the Mediterranean Sea, has been shown to be heart healthy. This diet includes daily consumption of vegetables, fruits, whole grains and healthy fats, such as olive oil; weekly intake of fish, poultry, beans and eggs; moderate portions of dairy products; and limited intake of red meat.
