Frequently Asked Questions

What is a Rheumatologist?*

A rheumatologist is an internist or pediatrician who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones.  Many rheumatologists conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases.

What Do Rheumatologists Treat?*

Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis. There are more than 100 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia and tendonitis. Some of these are very serious diseases that can be difficult to diagnose and treat.

What Is Dr. Franco's Interest In The Field of Rheumatology?

     Dr. Franco believes that infections trigger different forms of arthritis.  These infections are caused by various micro-organisms that include bacteria, mycoplasma, viruses and parasites. They may trigger rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus, scleroderma, dermato/polymyositis, reactive arthritis/post infectious arthritis, and others.

When Should You See a Rheumatologist?*

     If musculoskeletal pains are not severe or disabling and last just a few days, it makes sense to give the problem a reasonable chance to be resolved. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician. Many types of rheumatic diseases are not easily identified in the early stages. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. It's important to determine a correct diagnosis early so that appropriate treatment can begin early. Some musculoskeletal disorders respond best to treatment in the early stages of the disease.

     Because some rheumatic diseases are complex, one visit to a rheumatologist may not be enough to determine a diagnosis and course of treatment. These diseases often change or evolve over time. Rheumatologists work closely with patients to identify the problem and design an individualized treatment program.

How Does The Rheumatologist Work With Other Health Care Professionals?*

     The role the rheumatologist plays in health care depends on several factors and needs. Typically the rheumatologist works with other physicians, sometimes acting as a consultant to advise another physician about a specific diagnosis and treatment plan. In other situations, the rheumatologist acts as a a manager, relying upon the help of many skilled professionals including nurses, physical and occupational therapists, psychologists and social workers. Team work is important, since musculoskeletal disorders are chronic. Health care professionals can help people with musculoskeletal diseases and their families cope with the changes the diseases cause in their lives.

Is Specialty Care More Expensive?*

     You may be surprised to learn that specialized care may save time and money and reduce the severity of disease. A rheumatologist is specially trained to spot clues in the medical history and physical examination. The proper tests done early may save money in the long run. Prompt diagnosis and specially tailored treatment often save money and buy time in treating the disease.

What Happens On a Patient's First Visit to The Arthritis Center of Riverside?

     Dr. Franco and/or Dr. Lallande perform a detailed interview and a thorough physical examination. The laboratory test results and x-rays requested are interpreted in order to arrive at a precise diagnosis. This is extremely helpful in formulating the appropriate treatment plan for each individual patient.

What Laboratory Work Up and X-Rays Will Be Done?

     Every attempt is made to detect and confirm the possibility of an underlying infection. The severity of the illness is assessed with pertinent laboratory tests and X-rays. The X-ray equipment delivers less radiation than other frequently used X-ray equipment.

Where Are The Laboratory Tests Performed?

     Most of the test are done at the Arthritis Center of Riverside (ACR). The ACR has a state of the art Physician Office Laboratory (POL) where the tests are performed under Dr. Franco's supervision. Some tests may be referred to the best  outside reference laboratories.

What Does The Treatment Consist Of?

     The treatment consists of specific antibiotics, nutraceuticals/medical foods and conventional drugs used in a Rheumatology practice when appropriate. For patients not inclined to use conventional treatment, we have observed that 50% of effectiveness of the treatment is derived from the antibiotics and the other 50% is from pertinent nutraceuticals/medical foods.

What Antibiotics Do We Use?

     The antibiotics include those of the tetracycline family such as Doxycycline (Vibramycin) and Minocycline (Minocin). Also, the antibiotics of the macrolide family including erythromycin,  azithromycin (Zithromax) and clarithromycin (Biaxin). Other antibiotics are used when appropriate such as oral or intravenous Clindamycin.

What Are The Side Effects Of These Antibiotics?

     The potential side effects of antibiotics are multiple but infrequent. Careful monitoring for side effects (bone marrow, liver, kidney, skin and others) enables us to detect these possible problems early on. These side effects are most often reversible after stopping the antibiotics. The potential side effects of dysbacterosis including antibiotic associated colitis can be prevented by administering live cultures of friendly bacteria ( Lactobacillus acidophilus, and Bifidobacterium). When yeast (candida) infections occur, they are treated appropriately with natural or prescription antifungals. The resistance to these antibiotics is infrequent even with long-term administration. Overall these antibiotics have a good safety profile.

What Is The Treatment Duration?

     The antibiotic treatment lasts months or years. The nutraceuticals/medical foods suggested are tailored to each individual. The whole treatment is based on Dr. Franco's beliefs and research findings that microorganisms including mycoplasmas trigger/ cause inflammatory forms of arthritis.

What Is Our Experience?

     Dr. Franco has extensive experience in the treatment of rheumatic diseases in general and in particular with the rheumatologic disorders triggered/caused by infectious agents. Dr. Franco has treated several thousand patients with different rheumatic diseases over more than twenty years with good results. Approximately 80% of RA patients do respond with variable degrees of improvement. Dr. Franco estimates that up to 1/3 of patients with RA can go into remission within five years. For further information, see study conclusions.


**Important message from A. Robert Franco, MD**
      I often find that patients that come to see me for diagnosis and treatment for rheumatic diseases have already started on antibiotic treatment. Although this may be helpful to the patient, it would be best when applicable to have the appropriate work-up PRIOR to starting on antibiotic treatment. I am referring especially to the mycoplasma and chlamydia PCR test (genetic fingerprint).

     Antibiotics may render this test negative and thereby often making useless this great diagnostic tool, especially in view of the fact that patients will be obliged to use antibiotics for several years exposing themselves to some potential toxic side effects. If you have already started antibiotics, you should continue and consider going off for 4 weeks prior to your visit to the Arthritis Center of Riverside, or your physician's office where these tests may be ordered.

     If it is possible to do the above, you will increase your chances of confirming the infectious cause of your rheumatic disease. Even more so by doing the test prior too initiating antibiotic treatment, your insurance company will be more likely to authorize and pay for IV treatment if you have a positive mycoplasma PCR test.



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Arthritis Center of Riverside
11725 Slate Avenue
Riverside, CA  92505
Tel: 951.352.1700
Fax: 951.352.9117

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     *The information in this website is not intended to replace a rheumatology textbook nor be a complete update of the rheumatology scientific literature.  It should not be misconstrued as personal medical advice.  Rather, it portrays Dr. Al Robert Franco's interests in the field of rheumatology, namely, the interrelationship between infections and rheumatic diseases and how this applies to the treatment of arthritis.