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Co-Management

Co-Management

Co-Manage With Your Other Specialists

Co-Management

There are many autoimmune conditions which affect specific organ systems that other specialists often request consultation for co-management with the rheumatologist. This is typically for confirmation of a suspected diagnosis, request for specific treatment such as infusion, or management of musculoskeletal manifestations secondary to the primary disease. Alongside your other specialists, common co-managed autoimmune conditions are:

Psoriasis

This is a common chronic condition which whereby skin cells multiply too fast causing cells to accumulate and form grayish or reddish scales and itchy, dry plaques and patches that come and go. Triggers for these plaques are stress, infections, and cold temperatures. The rash can occur anywhere on the body but is commonly found on the elbows, knees, scalp and hairline. Treatment aims to heal the plaques and stop skin cells from growing so quickly. Your dermatologist will treat with topical ointments and creams, light therapy, and certain oral medications, but if the psoriasis remains uncontrolled, consultation with the rheumatologist may be recommended to consider stronger oral medications, injections or infusions. If there is suspicion of also having psoriatic arthritis, that also warrants a referral to the rheumatologist.

Cutaneous Lupus

Cutaneous lupus refers to skin rashes associated with lupus. There are many different forms such as the classic “butterfly rash” of acute cutaneous lupus on the face, discoid lupus which appears as coin shaped lesions, and lupus panniculitis where the subcutaneous fat can become inflamed. Lupus rashes photosensitive, which means they get worse with sun exposure. Cutaneous lupus can co-exist with systemic lupus or exist by itself. Initial treatment includes avoidance of sun exposure, avoiding stress, topical treatments, and injections of steroid under the skin. Your dermatologist will request consultation with the rheumatologist if systemic lupus is suspected, or additional treatment is needed for severe cutaneous lupus with oral medications or infusion.

Lupus Nephritis

When lupus causes inflammation of the kidneys, it is called lupus nephritis. It can present as the only manifestation of systemic lupus, or it can co-exist with lupus symptoms affecting other body parts. It requires a kidney biopsy to confirm the diagnosis and also classify what stage it is in. Left untreated, it can lead to kidney failure requiring dialysis. Mild stages are managed by your nephrologist with watchful waiting and blood pressure control. More severe stages require oral medications. If lupus nephritis remains uncontrolled the nephrologist will initiate stronger oral medications or infusion and frequently request input in conjunction with the rheumatologist.

Noninfectious Uveitis

Uveitis refers to inflammation of the middle layer of the eyeball. This can be due to infectious organisms which would be treated with antibiotics by your ophthalmologist. When it is not due to an infection, it could either be secondary to an underlying rheumatologic condition such as spondyloarthropathy or rheumatoid arthritis or others, or idiopathic meaning no clear underlying cause identified. The ophthalmologist will request consultation with the rheumatologist to help clarify if there might be an underlying cause. Uveitis can affect one or both of the eyes, and can come and go, but can become continues and chronic. If left untreated, uveitis can lead to blindness. If it remains uncontrolled despite local eyedrop treatments, your ophthalmologist will request consultation with the rheumatologist for oral medications, injections or infusion.

Autoimmune-Associated Interstitial Lung Disease

Interstitial lung disease (ILD) refers to when the lung tissue is inflamed, and if it progresses the inflammation will eventually turn into scar tissue that is stiff and damaged and oxygen does not pass through it very well. That end stage is called pulmonary fibrosis. ILD can be associated with an underlying rheumatologic condition such as rheumatoid arthritis, Sjogren’s syndrome, scleroderma, dermatomyositis, and mixed connective tissue disease. Your pulmonologist will treat breathing symptoms associated with ILD with steroids, inhalers, supplementary oxygen if needed, and use medications to prevent further progression of ILD into developing irreversible scar tissue. When an underlying rheumatologic condition is suspected, consultation with the rheumatologist is requested to confirm suspicion of the diagnosis.

IBD-Associated Spondyloarthritis

Episodic or chronic inflammatory arthritis can be associated with Crohn’s Disease and Ulcerative Colitis, which are the most common types of inflammatory bowel disease (IBD). Sometimes the musculoskeletal manifestations can flare up even though the gut is in remission. Your gastroenterologist will request consultation from the rheumatologist if it is suspected to assist in getting symptoms under control. This may require adding an oral or injectable medication, or deciding to change the main IBD treatment in conjunction with your gastroenterologist.

Antiphospholipid Syndrome

Antiphospholipid Syndrome (APLS) is characterized by the presence of abnormal proteins in the bloodstream called antiphospholipid antibodies. These antibodies can make the blood more prone to clotting in veins and arteries. This can manifest as deep vein thrombosis or clots found in the deep veins of the extremities, pulmonary embolism or a sudden big clot blocking a major lung artery, stroke due to clots in the brain circulation, or recurrent pregnancy losses due to clots in the placenta’s circulation. APLS can occur by itself (primary APLS) or be caused by another underlying condition (secondary APLS), commonly associated with systemic lupus. This more commonly affects women more than men. Some people can have APLS antibodies present in their bloodstream transiently due to other sources of inflammation, and then they go away. Other people can have APLS antibodies present in their bloodstream but not have any manifestations of clots as described. The amount of risk of clotting and the decision to treat with blood thinners and consequent risk of bleeding is a careful decision weighed by your hematologist. When APLS antibodies are found, commonly by your OB/GYN or hematologist, consultation with the rheumatologist is requested to evaluate for the possibility of systemic lupus or other rheumatologic condition.

Leukocytoclastic Vasculitis

A form of small vessel vasculitis, this disease typically presents with a red painful, burning rash starting on the lower extremities, that spreads upward. Small pinpoint rash is called “petechiae” and when they coalesce into big patches of rash that is called “palpable purpura.” Leukocytoclastic vasculitis can be an adverse reaction to medications, due to infections or herald a malignancy, occur idiopathically, or be secondary to a systemic vasculitis or other rheumatologic condition. This usually is biopsied by the dermatologist to confirm the diagnosis. Treatment involves discontinuation of a drug if it is deemed to have caused the rash, or treatment the underlying cause if found. If the rash doesn’t go away on it’s own or respond to courses of steroids, and if workup of an underlying rheumatologic cause is needed, your dermatologist will request referral for further evaluation and treatment with oral medications, injections or infusion.

What Our Patients Are Saying

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Most Personable Rheumatologist

Dr. Lomibao has been my Rheumatologist for over 4 years. I have had RA for 25 years, and Dr. Lomibao by far is the best doctor I have seen. She is an excellent and experienced physician who truly listens and cares. She has developed a treatment plan that has given me my life back.

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Phenomenal Physician

I am so thankful to be under the care of Dr Lomibao! I could honestly write an essay about her and how wonderful she is. From my first visit to the present she is always thorough and has a incredible bedside manner. I don't think I've ever waited more than 10-15 minutes in the office either. They are so efficient. I have recommended her to many people and will continue to do so. I love Dr Lomibao!

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Exceptional Physician

I am so thankful to have found Dr Lomibao. She's been my rheumatologist since the very beginning of my autoimmune illness journey and I can't say enough good things about her. She spent so much time at my initial getting to know me and my symptoms and now I've been a patient of hers for over two years and she still spends all the time with me I need to get my questions and concerns addressed. She is so thorough and has the best bedside manner. I have recommended her to many friends. Dr lomibao is a fantastic physician.

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The Best Rheumatologist

I could write a whole story. I won't because you may stop reading. Dr. Lomibao is the best I've came across during my search for a rheumatologist. She isn't like most doctors. She listens to you. She doesn't force meds on you and actually cares about your well being. I'm a lupus and arthritis patients. She has assisted me in getting my condition under control. If you want a caring doctor come see her and I promise you will not be disappointed.

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Great Rheumatologist

I was diagnosed with lupus almost 4 years ago and after searching. I finally found a rheumatologist who listened. She was compassionate and caring. She has never tried to force a treatment or force meds. Dr. Lomibao has the best bedside manner and communicates with all my other doctors so we are all on the same page. She's such a great doctor I pay out of my pocket to see her because she isn't in my insurance network. That should tell you my true thoughts about Dr. Lomibao. If you are looking for a doctor who will listen and help you find a solution. Go see her.

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She helped me knock my arthritis to the curb!

I had some difficulty with my arthritis and I wasn't particularly thrilled with my previous doctor's treatment plan. I decided to see Dr. Lomibao because there had to be another option. I was soooo glad I did!! Dr. Lomibao sat, listened and took notes like crazy. She really listened to my concerns and why I didn't want to be on steroids. When I finished, she put her pen down, looked me in the eyes and told me, "We will find something to help you." She reviewed all my options and provided the pros/cons on everything I could do. She provided me her most recommended options and then I was able to choose the best fit for me. It took a little bit of time, but I am now on a regimen that has my arthritis at the curb! You will not find a more personable, knowledgeable and caring physician around.

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One of the Best to ever do it!!!

I have been seeing Dr. Lomibao for almost 2 years. Follow-up hospital visit. She was new to me on our first visit she sat and asked so many questions in regard to the new diagnosis of my auto-immune disease. At first glance, some told me she looks young and she may not be as knowledgeable as others. I say to them she is freaking awesome and amazing. I never feel rushed or feel like I'm being pushed out quickly. Not that I take a lot of time but, as a patient you want to feel like your Dr. truly cares about what you're going through and find a way to solve the problem. During this recent pandemic, I've been teaching from home. I had to move my daughter home from college and I had to work the very next day. I was exhausted and had an appointment with Dr. Lomibao the very next day. My body was not cooperating and I left a message with her nurse and my Dr. did a virtual appointment to address my issues. Video or by phone was optional. They always return calls and are accommodating. God Bless you guys stay safe!

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I love Dr. Lomibao

Dr. Lomibao was the first Rheumatologist I saw after I started exhibiting symptoms of inflammatory arthritis in 2018. I have been appreciative of her analytical and compassionate nature since my first appointment! Dr. Lomibao doesn't just check boxes off her chart and move on to her next patient. During my appointments, she takes the time to relate to me and allows me space to communicate the various areas of my life that are affected by my illness. This has greatly affected the amount of trust I have for her. I am an over-thinker who loves knowing why and how aspects of my illness are affecting me, and Dr. Lomibao has never dismissed my questions or made me feel like I am wasting her time by asking a question. Dr. Lomibao and her staff have gone above and beyond to make me feel the best I possibly can! I am very grateful for their care.

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Caring and Open Expert Physician

I highly recommend Dr. Frances Lomibao if you are looking for a knowledgeable, kind, and proactive rheumatologist. Dr. Lomibao diagnosed me with RA this year, and has been so compassionate, caring, and informative every step of the way. She takes time to answer my questions in depth, and I always have a lot of them. She is open to my desire to find a way to treat this disease as holistically and naturally as possible, and I truly feel that we are a team united in the fight. Visiting with Dr. Lomibao feels like meeting up with a friend. I’m always nervous before doctor visits but her presence is so comforting, and she’s hilarious! She helps take the edge off of potentially receiving tough news. When we found that I would need to take medication (which wasn’t my plan originally), she spent so much time with me discussing treatments and helping me find what’s best for me. She made me feel comfortable with my treatment plan, and I appreciated her boldness to tell a crunchy hippie like me that while diet and lifestyle changes and supplements would help, it wouldn’t be enough for how my disease is progressing. I have a long history of poor medical care, so being able to partner with Dr. Lomibao is a true blessing.

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Five Stars

I have been under Dr. Lomibao's care for 2 1/2 years. She is an amazing rheumatologist that has a genuine care for her patients. I have had RA for 15 years and seen many doctors but she is by far the very best! If you need a physician who not only cares but gets to the bottom of your condition, look no further. I HIGHLY recommend Dr. Frances Lomibao! God bless her!

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