Article originally published Spring 2024 in The Monitor magazine.
A Joint Effort
Toni Reincheld is one of more than 50 million Americans who suffer from arthritis and the severe pain that comes with it. For years, the 62-year-old Newark resident experienced all of the hallmark symptoms of the disease, such as aching pain, stiffness and swelling in her joints. When two knee replacements in 2019 revealed a diagnosis of rheumatoid arthritis, Toni’s orthopedic surgeon referred her to rheumatologist Sheryl Mascarenhas, MD, who was practicing in Columbus at the time.
“The pain I had was horrible. I felt like I couldn’t even really get up to do anything, and if I did try to do something, I would have to sit right back down,” Toni said.
Toni knew she was in good hands from her very first appointment with Dr. Mascarenhas; in addition to noticing improvement with her symptoms, Toni also liked her new provider’s kind demeanor. When Dr. Mascarenhas accepted a position at Fairfield Healthcare Professionals Rheumatology in 2022, Toni decided to follow her. “She’s so thorough, and she really cares about her patients. I knew I needed to continue seeing her because she had been such a saving grace to me,” Toni said.
Dr. Mascarenhas quickly identified and diagnosed Toni with three types of arthritis – rheumatoid arthritis (RA), osteoarthritis (OA) and pseudogout. RA is an autoimmune and inflammatory disease that occurs when a person’s own immune system mistakenly attacks the joints. OA, the most common form of arthritis, is non-inflammatory and occurs when the cartilage that caps the bones in the joints wears down over time, usually in the hands, hips and knees.
“It is rather common for patients with RA to have more than one type of arthritis over the course of their lives, and the one I see most with RA is OA,” Dr. Mascarenhas said. “Some studies suggest having RA can make you three times more likely to develop OA.”
Pseudogout occurs when calcium crystals develop in the blood and settle in the joint cartilage, leading to sudden flare-ups and painful inflammatory attacks, usually in the knees, wrists or ankles. According to Dr. Mascarenhas, patients with RA can be more likely to develop the calcium deposits that cause pseudogout flare-ups.
Diagnosing rheumatic conditions can be difficult, but innovative diagnostic methods are helping rheumatologists find these conditions earlier. Traditionally, joint conditions are diagnosed through a physical exam, blood work or imaging, but musculoskeletal ultrasound is a tool that can help achieve early diagnosis.
“I use ultrasound to look for early stages of a rheumatic condition because it allows us to look at the soft tissues around the joints that are affected before we start to see the irreversible damage that happens later,” Dr. Mascarenhas said.
Over the years, Toni has put her full trust in Dr. Mascarenhas to treat the symptoms caused by her arthritis. As a result, her pain, joint function and swelling have improved significantly. Her treatment plan includes medications and intramuscular injections, in addition to local cortisone injections into her joints to target the inflammation. The therapies work by blocking part of the immune signals that cause inflammation in autoimmune rheumatic joint conditions. Various methods to relieve symptoms are often needed in cases where patients, like Toni, have multiple types of arthritis.
“When I was in pain, I could hardly walk. It was terrible, but she helped me through it,” Toni said. “It took some trial and error to find the medication that worked best for me, but Dr. Mascarenhas was determined to find the right fit.”
Toni also praises the FHP Rheumatology office staff for offering a warm, welcoming environment for patients and even helping her through insurance processes.
“I’ve never experienced such friendly staff at a doctor’s office,” Toni said. “I want everyone to know that when they go in that office, every single person is going to help them the best they can.”
Despite her progress, Toni experienced an unexpected setback in January 2023 when she noticed new pain that “felt like a ball” in her back. She had also shrunk about 1.5 inches in height. “RA does not directly affect the lower back, so I knew something else was causing these symptoms,” Dr. Mascarenhas said. “The shrinking itself was quite concerning.”
Suspecting that Toni had compression fractures, Dr. Mascarenhas ordered X-rays. The imaging confirmed that Toni had three compression fractures in her back.
“I think I was exercising when the fractures happened, but I didn’t pay much attention to it at the time, so I’m very thankful she found them,” she said. “That’s just one instance where she’s shown how meticulous she is. I’m not sure I would have known what was causing that back pain otherwise.”
To repair the fractures, Toni underwent a vertebroplasty, in which a cement-like substance is injected into cracked vertebrae, or spinal bones. Now on a maintenance schedule with her symptoms ultimately managed by Dr. Mascarenhas’ ongoing treatment plan, Toni is pain-free and enjoying time with her husband, Dave Reincheld, and her beloved chihuahua.
“She’s a wonderful person and an awesome doctor,” Toni said. “I don’t know where I’d be today if it wasn’t for her. I’d be in a lot worse shape.”
