In This Community Health Clinic, the Rheumatologist Is In

In this week's Rheumatology Network news roundup, we highlight an interview we conducted with Brian LaMoreaux, M.D., M.S., a medical director at Horizon Therapeutics and a volunteer clinical rheumatologist with CommunityHealth in Chicago. In this interview, he shares with us his experience as a rheumatologist in a community where healthcare is not always easy to come by. Dr. LaMoreaux has been volunteering with CommunityHealth for about two years.

“Seeing patients is very important to me. When I was talking with Horizon [about joining their team], it was really important that I continue to see patients. The clinic is really a wonderful place. They have a strong network of primary care physicians, but they don’t have a lot of specialty access, specifically to a rheumatologist. The clinic sees a fair number of undocumented immigrants---primarily Spanish and Polish speakers. I’ve built a panel of about 50 to 70 patients and I’m seeing a lot of rheumatoid arthritis cases, lupus, and polymyalgia rheumatica cases.”

Most of the CommunityHealth patients have continued to work full-time, despite a diagnosis of rheumatoid arthritis or other rheumatic condition. Some are working through the COVID-19 pandemic in high risk environments and others are sheltering I place, he said.

“There’s just a need for good medicine. These are patients who are by definiation a bit vulnerable. And, they may have some distrust of medical systems, which is one of the things community health really strives to overcome and alleviate at every opportuinity. Some of them, in fact most, are still working full-time [during the COVID-19 pandemic]. When you have really profound rheumatic diseases, it’s a little less common to maybe work full time, but a lot of these patients do manage quite well because they have to for their famlies,” Dr. LaMoreaux said.

“Some of their diseaes have gone on for a while without some of the interventions you woud like [to see as a physician],” he said.

CommunityHealth depends on the donations of other companies allowing them to make therapies available to patients through compasionate use programs.

“It almost feels like two-and-a-half months ago when hydroxychloroquine (Plaquenil) was touted as  a cure or answer for COVID-19. The subsequent data has really shown quite the opposite-that it really doesn’t seem to show much of an effect. Because all of our Plaquenil is donated, we were concerend about runing out, so I reviewed all of the charts of patients on this medicine. I tried to reduce folks from twice a day to once a day. If someone could go off it safely, I did that. And, if folks needed it, I kept them on,” he said.

This Chicago community is not seeing the downward trend in COVID-19 cases that other communities are seeing, Dr. LaMoreaux said. His concern is that a surge in cases is imminent, and that frightens patients.

“We hope that all of this mandatory social distancing has done the job and we’re seeing things go the right way, but patients are still concerned. Sometimes when I ask them to come in for medication refills, they say, ‘I don’t want to go out side.’ Or, they ask, ‘Is it safe to go outside?’ You kind of have to balance that anxiety with autoimmune disease,” he said. When autoimmue disease goes untreated, it could lead to dangerous flares that may require hospitalization.

The introduction of telemedicine in rheumatmology has resolved fears patients may have had about in-person doctor visits during the pandemic, but not all patients have access to computers or mobile phones with video capability.

“For the things that have to happen in person, you find ways to minimize risk for eveyrone involved. Rheumatology has done this. I’ve been very impressed with my field and my colleagues in how we have found ways to provide great care to our patients-even in these trying unsusal times,” he said.