Stiff in the morning, tired all the time, and told it’s just stress or aging? In this episode of Myths to Medicine, host Ashma Baruwal sits down with Dr. Ofelya Gevorgyan, a board-certified rheumatologist, to explain what rheumatology really covers. They also discuss when joint pain should worry you and what patients need to know about rheumatoid arthritis, lupus, and gout before symptoms get worse.

In This Episode

• What rheumatology actually is: a field built around a “confused immune system” that can attack the joints, skin, kidneys, heart, and nervous system
• Why Dr. Gevorgyan calls her work medical detective work, and why rheumatologists treat the patient, not just the disease
• Osteoarthritis vs. rheumatoid arthritis: mechanical wear and tear vs. inflammation that can strike at any age, including in children
• How rheumatoid arthritis is diagnosed: clinical judgment first, with blood tests like rheumatoid factor and anti-CCP, inflammation markers, ultrasound, and MRI as support
• Why up to 20% of people with rheumatoid arthritis have normal antibody blood tests, and why that makes diagnosis a waiting game
• Rheumatoid arthritis and pregnancy: the myth that symptoms always disappear, the risk of postpartum flares, and why pregnancy should be planned in advance
• How treatment evolved from gold shots and painkillers to methotrexate, biologics, and oral JAK inhibitors
• Lupus explained: why it’s nine times more common in women, why it tends to be more aggressive in men, and whether it’s hereditary or curable
• Why rheumatoid arthritis is an independent risk factor for heart disease, with a cardiovascular risk Dr. Gevorgyan calls comparable to diabetes
• Gout, the “disease of kings”: which foods trigger it, a listener question on tuna, and why exercise is part of arthritis treatment

“We need to treat the patient, the individual, not the disease.”

When to See a Doctor About Joint Pain

Dr. Gevorgyan recommends starting with your primary care physician, who can decide whether you need a rheumatologist. Get checked if you notice:

• Joint pain lasting more than 4–6 weeks that doesn’t improve with over-the-counter medications like acetaminophen or NSAIDs
• Joint pain alongside unexplained fatigue, weight loss, loss of appetite, skin lesions, or neurological symptoms
• Joints that are swollen, hot, red, deformed, or hard to move
• Morning stiffness that lasts a long time; some patients need 30–45 minutes or a warm shower before they can move
• A single swollen joint that lasts about 6 weeks, or joint swelling that comes and goes over months

Myths vs. Facts

• Myth: Rheumatoid arthritis goes away during pregnancy. Fact: A little over half of patients improve, but many flare, especially those who stop their medication. Active disease doesn’t cause infertility, but it can make conception harder. Flares during pregnancy are linked to preterm birth.
• Myth: Lupus can be spotted from one symptom, like a facial rash. Fact: Lupus mimics many other conditions and can show up as anything from a skin rash to kidney failure. It needs a full medical evaluation, not self-diagnosis.
• Myth: Gout is a disease of kings. Fact: That reputation dates to when only royalty had easy access to meat and alcohol. Today, gout can affect anyone.
• Myth: Anti-inflammatory diets are just internet hype. Fact: According to Dr. Gevorgyan, food does matter and can ease symptoms. Diet cannot replace medication once rheumatoid arthritis has developed.
• Myth: If your joints hurt, you shouldn’t exercise. Fact: Exercise is part of the treatment plan. Movement is good for joints, even sick ones.

Eating for Gout & Inflammation

• Limit for gout: Red meat, organ meats like liver, shellfish, and alcohol, especially beer. These are rich in purines, which raise uric acid.
• Tuna: It’s moderately high in purines. Dr. Gevorgyan suggests one to two servings a week, with canned tuna lower-risk than raw.
• Better choices for gout: Dairy, fruits, and vegetables
• Anti-inflammatory staples: These include omega-3-rich foods like mackerel, chia seeds, and walnuts. She also lists extra virgin olive oil, berries, leafy greens like kale and spinach, whole grains like quinoa, and spices like turmeric and ginger.
• Pro-inflammatory foods: Refined sugar, ultra-processed and fast food, and certain red meats. Some patients also notice flares from gluten or nightshade vegetables, though this isn’t universal.

Exercise as Treatment

• Aim for 150–300 minutes a week of moderate, low-impact cardio such as walking, biking, or swimming
• Add muscle strengthening, either weightlifting or isometric exercises that build muscle without moving the joint
• Stretch daily, whether at home or through yoga or tai chi, and add balance exercises
• Consider seeing a physical therapist first so the plan matches your current abilities

About the Guest

Dr. Ofelya Gevorgyan is a board-certified rheumatologist based in Tacoma, Washington, with more than six years in practice. She has extensive experience treating rheumatoid arthritis, osteoporosis, and other autoimmune conditions. She says rheumatology appeals to her because it allows long-term relationships with patients.