Rheumatologist OnCall

03/29/2026

Can Diet Cure Ankylosing Spondylitis (AS)?

The internet says "go gluten-free and cure your AS."

Science says: not so fast. 🧬

Diet cannot cure Ankylosing Spondylitis — but the RIGHT nutrition strategy can lower your inflammation markers, reduce flares, support your gut microbiome, and make your medications work BETTER.

Dr. Vishnuteja Devalla, MD — Ivy League-trained Rheumatologist — breaks down what the research actually says about diet and AS.

This is the conversation your Instagram feed isn't having. 👇

🎙️ Full episode → Thriving with Arthritis Podcast:
https://podcasts.apple.com/us/podcast/ankylosing-spondylitis-what-patients-and-doctors/id1733575518?i=1000756756699

📲 Book a telehealth consultation with Dr. Devalla (20 states):
🌐 rheumatologistoncall.com
📞 (650) 525-4404

03/28/2026

"There's nothing you can do. Just learn to live with the pain."

If you have Ankylosing Spondylitis and a doctor has ever said this to you — this post is for you.

🚨 This is one of the most damaging myths in rheumatology — and it is completely FALSE.

Dr. Vishnuteja Devalla, MD, board-certified Rheumatologist trained at Dartmouth-Hitchcock Medical Center, breaks down what is actually available for AS patients right now:

✅ NSAIDs — first-line treatment to reduce inflammation and pain
✅ TNF inhibitors (Humira, Enbrel, Remicade) — proven to slow disease progression
✅ IL-17 inhibitors (Cosentyx, Taltz) — targeted biologics with life-changing results
✅ JAK inhibitors (Rinvoq, Xeljanz) — newer oral medications giving patients real relief
✅ Anti-inflammatory nutrition — science-backed dietary strategies that reduce flares
✅ Physical therapy & exercise — movement is medicine for AS, not the enemy
✅ Mindfulness & stress management — because chronic pain affects your whole life

The treatment landscape for AS has never been more advanced.

What hasn't changed? Too many patients still being told to "just deal with it" because they haven't seen the right specialist.

Early treatment doesn't just manage symptoms — it can prevent permanent spinal damage.

Don't wait.

🎙️ Listen to the full episode on the Thriving with Arthritis Podcast:
https://podcasts.apple.com/us/podcast/ankylosing-spondylitis-what-patients-and-doctors/id1733575518?i=1000756756699

📲 Book a telehealth consultation with Dr. Devalla — available in 20 states:
🌐 rheumatologistoncall.com
📞 (650) 525-4404

Save this and share it with someone who has been dismissed by their doctor. They deserve to know there ARE options.

03/27/2026

03/26/2026

When should you take Prednisone?

They call it "the miracle drug."

24 hours later, you feel AMAZING. No pain. No stiffness. You're moving again.
So why can't you just stay on it forever?

Because Prednisone is a miracle AND a monster.

Short term (days to weeks): Stops flares fast, reduces pain, buys time for other meds to work.
Long term (months to years): Weight gain, bone loss, diabetes, high blood pressure, mood changes, insomnia, infections, moon face, adrenal suppression.

The problem? Too many patients get steroids too easily and stay on them too long.

Your doctor keeps refilling it. Month after month. You gain 30 pounds. Your face is puffy. Your bones are thinning. You can't sleep.

But you're terrified to stop because the pain comes roaring back every time you try.

This happens when Prednisone becomes the TREATMENT instead of the BRIDGE.

If you've been on Prednisone for more than 3 months, something is wrong with your treatment plan.

You either need:
- A different DMARD or biologic
- A higher dose
- Combination therapy
- Better management

We understand this medication better than anyone. At OnCall, we use Prednisone strategically with an EXIT PLAN from day one.

We don't let you live on steroids because we're too slow to fix your real treatment.

Dr. Devalla, Dr. Girnita, and Dr. Titianu know exactly when Prednisone helps and when it hurts.

Stuck on long-term Prednisone? We help you safely taper off while getting on medications that actually control your RA.

Need rescue therapy for a flare? We prescribe it appropriately with a clear plan.

Stop living on steroids. Start treating the disease.

📞 (650) 525-4404
🌐 RheumatologistOnCall.com

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03/25/2026

Why can't I just get the medication I saw on TV?

You see the commercial: Happy people hiking, playing with grandkids, living their best life. You think: "That's what I need! That medication will fix everything!"
You ask your doctor. They say no. You're confused. Frustrated. Angry.

Here's what those TV ads don't tell you: Those medications are FLASHY, EXPENSIVE, and heavily marketed. But they're not always YOUR best choice.

The reality behind drug advertising: Pharmaceutical companies spend $6 BILLION yearly on direct-to-consumer ads. They're selling you a dream, not personalized medicine.

Is that smiling woman hiking? Paid actor. Not a real patient.
Those "results" shown? Best-case scenarios from cherry-picked clinical trial data. The fine print you can't read? Lists of side effects and contraindications that might make that drug WRONG for you.

reality: We treat patients with YOUR disease EVERY SINGLE DAY. Not occasionally. Not as a side practice. EVERY DAY.

Dr. Devalla, Dr. Diana Girnita, and Dr. Mirela Titianu have collectively treated thousands of patients with rheumatoid arthritis, psoriatic arthritis, lupus, and other autoimmune diseases.

Our approach: We present you with ALL your options. Then YOU decide with complete information.

The happy faces on TV are actors. Our patients are REAL people getting REAL results with the RIGHT medication for THEIR case.

Not the flashiest drug. Not the most advertised drug.
The RIGHT drug.
📞 (650) 525-4404
🌐 RheumatologistOnCall.com

Stop asking for TV medications. Start getting expert-matched treatment.

Telehealth available in: AL, AZ, CA, FL, GA, ID, IL, IN, KY, MD, MI, MN, MT, OH, OK, OR, PA, TX, WI

03/24/2026

Most women expect menopause to announce itself with hot flashes. But for many, estrogen doesn't go out with a bang. It quietly disappears — and takes everything with it.

Here are 5 signs it's already happening:

1. You wake up at 2, 3, or 4AM and can't go back to sleep.
This is not anxiety. This is progesterone — your natural calming hormone — dropping first. When progesterone disappears, your brain loses its off-switch at night.

2. Your joints ache and nobody can explain why.
No injury. Normal X-rays. Normal labs. But you're stiff every morning and achy by afternoon. Estrogen protects your cartilage and regulates joint inflammation. When it drops — your joints feel it immediately.

3. Your brain stopped working the way it used to.
You forget words mid-sentence. You walk into a room and don't know why. You can't focus the way you once could. Estrogen is a brain hormone. When it fluctuates — cognition, memory, and clarity all suffer.

4. Your mood changed and you don't recognize yourself.
Irritable for no reason. Anxious out of nowhere. Crying at things that never used to affect you. This is not a personality change. This is estrogen and progesterone destabilizing your brain chemistry.

5. You feel exhausted no matter how much you sleep.

Not tired. EXHAUSTED. The kind of fatigue that doesn't lift after a full night's rest. Hormonal decline affects your mitochondria, your cortisol rhythm, your thyroid function, and your ability to recover. Rest stops being enough.

If you recognize yourself in more than one of these — your hormones deserve a real evaluation. Not a dismissal. Not "it's just stress." Not "it's just aging."

A full hormone panel.
A doctor who listens.
A plan that addresses the root cause.

That is exactly what we do inside our Women's Hormone & Autoimmune Balance Program.

We evaluate hormone history, immune risk, inflammation patterns, and joint symptoms together — because your body doesn't work in isolated pieces.

📍 Telehealth available in California, Florida, and Oregon.

📞 Call 650-525-4404
🌐 Visit rheumatologistoncall.com

03/23/2026

Daily habits matter especially when you deal with arthritis like or .
Try these 5 habits, and you will thank us!

At Rheumatologist OnCall, we get it. But we can teach you how to protect your joints every day!

We don't lecture. We help.

📞 (650) 525-4404
🌐 RheumatologistOnCall.com

03/22/2026

If you have rheumatoid arthritis, Sjögren's, or another autoimmune condition and your doctor said "no" to hormone therapy without a real evaluation — you were likely denied care based on fear, not science.

Here is what the research actually shows:

The American College of Rheumatology recommends HRT for postmenopausal women with rheumatic disease who have menopausal symptoms and no major contraindications.

For rheumatoid arthritis — HRT has not been shown to worsen disease activity.

For Sjögren's syndrome — HRT can directly help the dryness that defines the disease.

For lupus — it depends on your specific antibody profile. But it is not automatically off the table.

And transdermal estrogen — patches and gels — does not increase blood clot risk, making it safe even for many women previously told they couldn't consider it.

The blanket "no" is not a medical decision. It is a gap in training.

Women with autoimmune disease are already fighting harder than most. They should not also have to fight for access to care that could reduce their inflammation, protect their bones, preserve their muscle, and give them their quality of life back.

The question was never whether you can have HRT.

The question is what the safest, most individualized approach looks like for your body.

Inside our Women's Hormone & Autoimmune Balance Program, we evaluate hormone history, immune risk, inflammation patterns, and joint symptoms together — never in isolation.

If you're in California, Florida, or Oregon, call 650-525-4404 or visit rheumatologistoncall.com to learn more.

Follow for more science-backed education on menopause, hormone therapy, and autoimmune disease.

03/21/2026

What if the age you reach determines your risk of arthritis?

A brand-new study published in 2025 followed Canadian women for 10 years to examine how age at natural menopause affects the future risk of developing rheumatoid arthritis (RA).

Here’s what researchers found:

Women who experienced at age 50 or later — and who used hormone replacement therapy (HRT) for 8 years or more — had an 80% lower risk of developing RA compared to women who had menopause before age 44 and never used HRT.

This reinforces a powerful concept: longer lifetime exposure to estrogen may protect against rheumatoid arthritis.

helps regulate inflammation and stabilize immune function. When menopause happens early, that protective window shortens. When estrogen exposure lasts longer, immune protection may last longer too.

This does not mean hormone therapy is right for everyone. But it does confirm what we are seeing clinically:

timing matters.
Hormone exposure matters.
risk is not random.

If you experienced early menopause — or if rheumatoid arthritis runs in your family — this is an important conversation to have.

Inside our Women’s Hormone & Autoimmune Balance Program, we evaluate hormone history, immune risk, inflammation patterns, and joint symptoms together.

If you’re in California, Florida, or Oregon, call 650-525-4404 or visit rheumatologistoncall.com to learn more.

Follow for more science-backed education on menopause, hormone therapy, and autoimmune disease.

03/20/2026

Feeling exhausted, foggy, achy, or anxious — but your doctor says everything looks normal?

The problem is not that nothing is wrong. The problem is nobody ordered the right tests.

Here is exactly what to ask for:

Estradiol (E2) — your primary estrogen; can be critically low even when periods are regular
Progesterone — the first hormone to drop in perimenopause; causes insomnia, anxiety, and mood instability
Free + Total Testosterone — essential for energy, libido, muscle mass, and brain clarity
SHBG — tells us how much hormone your body can actually use; high SHBG means your hormones are "locked away"
FSH + LH — confirms where you are in your hormonal transition

Also ask for: fasting insulin, full lipid panel, vitamin D, and free T3/T4.

Most doctors will not order these without being asked. Now you know to ask.

I'm Dr. Mirela Titianu, Menopause Specialist and Board-Certified Internal Medicine Physician. I give women the complete picture — not just a standard panel.

🔴 IN OREGON, CALIFORNIA, OR FLORIDA?
Stop guessing. Start knowing.
📞 650-525-4404
🌐 rheumatologistoncall.com
Telehealth available. No office visit required.

💬 Which of these labs has your doctor NEVER ordered? Comment below.

03/20/2026

Does menopause actually make arthritis worse?

A large study published in 2018 followed over 8,000 women with to answer exactly that question:

What happens to RA after menopause?

Here’s what researchers found:

• Premenopausal women had less functional decline.
• After menopause, functional decline accelerated and disease progression worsened.
• Women who used hormone replacement therapy (HRT) had less decline.

This wasn’t just about joint counts. It was about real-life function — walking, gripping, performing daily activities.

When estrogen declines during menopause, its anti-inflammatory and immune-regulating protection decreases. Immune activity can rise, and rheumatoid arthritis may become more disabling over time.

is not a neutral event in autoimmune disease. Hormone history and timing matter.

If you have rheumatoid arthritis and are entering or , this transition deserves proper evaluation — not just medication escalation.

In our Women’s Hormone & Autoimmune Balance Program, we assess RA disease activity, functional decline, bone health, cardiovascular risk, and hormone status together.

If you’re in California, Florida, or Oregon, call 650-525-4404 or visit rheumatologistoncall.com to learn more.

Don’t forget to follow for more science-based insights on menopause, hormone therapy, and autoimmune disease.

03/19/2026

Still in pain after 3 months on Methotrexate?

Your rheumatologist says "give it more time."

Meanwhile, you can't button your shirt. Can't walk without limping. Can't sleep through the night.

Here's what they're not telling you: Methotrexate works for only 40% of Rheumatoid Arthritis RA patients.

If you're still suffering after 3 months, you probably need a BIOLOGIC.

Biologics are more targeted. They work faster. They work better for moderate to severe RA.

But insurance makes you "fail" methotrexate first.
So you suffer for 6 months.
Sometimes a year.
Sometimes longer.

While your joints get damaged.

This is NOT okay. You don't have to wait years to feel better.

Remission should take MONTHS, not YEARS.

But you need a rheumatologist who will FIGHT for you. Who won't make you "give it more time" when you're in agony. Who pushes for biologics when you need them NOW.

That's what we do.

Dr. Devalla and Dr. Girnita work as a TEAM to get you into remission FAST.

We don't accept years of suffering as normal.
We fight insurance companies aggressively.
We're available when you're struggling.
We get you to biologics in weeks, not months.
Your pain is urgent. Your treatment should be too.

📞 (650) 525-4404
🌐 RheumatologistOnCall.com

Stop suffering. Start living.

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