a rheumatologist at NewYork-Presbyterian Brooklyn Methodist Hospital reveals the fascinating pathways to diagnosing and treating autoimmune disorders
By megan schade • photos by amessé photography
“Why, sometimes I’ve believed as many as six impossible things before breakfast.”
—The Queen, in Lewis Carroll’s Through the Looking-Glass and What Alice Found There
The Queen’s sentiment is one that is surely shared by many a rheumatologist. Rheumatology is a subset of internal medicine that diagnoses and treats systemic autoimmune disease and inflammatory conditions that affect the joints and connective tissue. The specialty can be nebulous and often overlaps other fields of study, including immunology, orthopedics, pulmonology, dermatology, and surgery.
The body’s immune system produces cells that fight infection and disease. When something in the immune system goes awry, these disease-fighting cells start attacking healthy cells. No one knows exactly what triggers the immune system to backfire, but genetic predisposition and environmental factors are known to play a part.
“Autoimmune diseases often mimic symptoms of other conditions, and the symptoms may appear in parts of the body that make no sense from a systemic point of view,” said Petros Efthimiou, M.D., associate chief of rheumatology at NewYork-Presbyterian Brooklyn Methodist Hospital. For instance, a patient with psoriasis might visit a dermatologist to receive treatment for her inflamed and red, patchy skin, never realizing that the increased joint pain in her fingers is part of the same disease: psoriatic arthritis. Or a woman may wake, confused by the combination of stiffness in her knees and a butterfly-patterned rash across her cheeks, not knowing the tell-tale signs of lupus, in which the immune system attacks healthy tissue in different parts of the body, causing painful inflammation.
Women experience autoimmune disorders significantly more often than men, and rates are highest among those with Hispanic and African ancestry.
“In my practice, I see a wide range of rheumatic diseases,” says Dr. Efthimiou, “from the relatively common lupus and rheumatoid arthritis [in which the lining of the joints becomes inflamed, causing pain and eventual bone degradation] to lesser known conditions like Behcet’s Syndrome or adult-onset Still’s disease. It is rare that a patient comes directly to me. Most often, patients are referred by their primary care doctors or emergency room physicians.”
There are no diagnostic tests that can specifically identify immune system disorders, so rheumatologists must be puzzle masters; they need to take seemingly disparate symptoms and look for the binding diagnosis.
Dr. Efthimiou attended the University of Ioannina Medical School in Greece, and then completed a residency in internal medicine at Rhode Island Hospital/Brown University and a combined fellowship in rheumatology at the Hospital for Special Surgery /NYP-Weill Cornell Medical Center in New York. He joined NYP Brooklyn Methodist in 2015.
“During my residency in Rhode Island, I was lucky to be mentored by a doctor whose passion for the field of rheumatology was palpable,” said Dr. Efthimiou. “His commitment to finding a diagnosis and the satisfaction he got from providing relief that had proven elusive for patients really inspired me.
“I love the cognitive challenge that rheumatology presents, not just arriving at the right diagnosis but then crafting the best possible treatment. No two patients with the same autoimmune disease will have exactly the same symptoms or degree of symptoms. Just as each person’s immune system is unique, the way it attacks is unique, and the treatment is no less unique.
“Because there is no cure for autoimmune diseases, we treat to mitigate the symptoms and to keep them from impacting quality of life. Pain and swelling can often be alleviated with nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen, and corticosteroids can slow an immune attack.
Dr. Efthimiou said that research into targeted therapies and treatments is exploding. Disease-modifying biologic drugs target the immune system and slow the disease’s progress. These drugs are often at the core of the course of treatment and are formulated to specifically address each individual patient’s disease. The medications may be taken orally or intravenously. “Our Hospital has its own infusion center, which allows for greater continuity of care and communication,” added Dr. Efthimiou.
“This is an exciting time in rheumatology, especially here at NYP Brooklyn Methodist. We are continuously working on and testing novel drugs for immune-based diseases to counteract or inhibit the cells that cause inflammation. Instead of merely alleviating symptoms, we are also often able to prevent the destabilizing cells from being produced to begin with. Under the direction of Placido Morano, M.D., our Division of Rheumatology has expanded significantly and we are able to share the new developments in the field with more and more resident physicians.”
“Petros has been very aggressive with state-of-the-art advanced biologic therapies for patients who have lived too long with chronic pain,” said Stephen Peterson, M.D., chairman of internal medicine. “He has really improved the patient experience for those with advanced rheumatologic disease.”
Dr. Efthimiou believes in helping people to live life to the fullest, and practices what he preaches. “When I am not working I am travelling the world—I’ve just returned from the north of Italy,” he said. “I’m an insatiable foodie, and love music. In fact, I am one of the consulting physicians for the New York Philharmonic. Although I live in Manhattan, working in Brooklyn has allowed me to witness its renaissance, and experience how wonderful its residents can be. I love being able to help them.
“I find my work extremely gratifying. Only a few decades ago, many of my patients would have been misdiagnosed or gone untreated. For those that did receive a correct diagnosis, treatments often exposed them to a variety of toxic drugs. I love the challenge of figuring out why a body has turned on itself, and developing a specialized treatment to counteract an autoimmune attack. It is so rewarding to watch patients heal and thrive.”
NewYork-Presbyterian Brooklyn Methodist Hospital
506 6th Street / 718.780.3000 / www.nyp.org/brooklyn