In a nutshell...

Hi, my name is Apostolos Kontzias and I am here for you and your primary doctor or sub-specialty physician to shed light in symptoms and signs that have long escaped a definitive diagnosis and treatment. 

• Have you had recurrent fevers in younger years or as adult and were always told that this was due to infections even though at times no infection was found? 
• Have you had rashes that were attributed to allergies but allergy testing has been negative or allergy testing could not explain the nature of your rashes? 
• Have you had recurrent chest pain of no cardiac cause? 
• Have you had unexplained swollen glands, on and off, mouth sores and/or abdominal pain with no reasonable diagnosis despite being seen by multiple specialists such as gastroenterologists, infectious disease specialists, hematologists or rheumatologists? 
• Do you have dry eyes, dry mouth, fatigue and have been tested negative for classic autoimmune diseases such as Sjogren syndrome?
• Is your treatment plan not effective in controlling your symptoms or you are intolerant to it or you have co-morbidities that make your case challenging to manage?

It may be the case that a diagnosis is elusive because your symptoms are caused by one of the rare conditions that only rheumatologists with subspecialized expertise can identify or your symptoms are part of an atypical presentation of common rheumatologic conditions that require high index of suspicion to confirm. 

I can relate to you and I certainly understand your frustration. This why I am here for you. 

Over the past 15 years I have had the opportunity to serve patients like you coming from across the globe in the institutions I was affiliated with such as the National Institutes of Health (NIAMS), Cleveland Clinic and Stony Brook Hospital. I have personally witnessed the uncertainty, the physical and emotional burden you and your family have been through by bouncing from specialist to specialist with no actionable answers.

The reality is that certain conditions especially rare ones require high index of suspicion and there is only limited access to experts in the field of autoimmunity and autoinflammation. I have come to realize that through my platform I can reach out to all patients in need through their physicians with no geographic and or time restrictions.

I am a firm believer of reflective rather than reflexive practice of medicine. Avoiding cognitive shortcuts to reach an accurate diagnosis rather than masking symptoms is a priority for me granted that empiric treatments at times may be necessary depending on severity of symptoms.

I have been in your shoes driven by our conviction as physicians to do the best we can for our patients. We all know that resources are finite and time is a precious commodity. But your patients deserve the best. Medicine is a team sport and we all rely on each other's observations and experience to offer our patients the best possible care as we would expect if our patient was a family member. 

During my 15 year-experience caring for patients with autoimmune and autoinflammatory conditions I have met patients with symptoms  spanning across disciplines. For example, patients with inflammatory eye disease referred to me by an ophthalmologist only to find out that patient's posterior scleritis was due to Cryopyrin associated Periodic Syndrome (CAPS); or a patient with recurrent pericarditis which may be a telltale sign of common or rare conditions requiring specialized treatment; or patients with recurrent aphthous painful oral ulcers which can be explained by variable autoimmune or autoinflammatory conditions evading diagnosis.

These are the patients that in my experience have fallen through the cracks of the system which promotes reflexive rather than reflective medicine simply because of the nature of some diseases and the time constrains in our practices.

Autoimmune and autoinflammatory conditions often masquerade as other common ones requiring high index of suspicion to diagnose accurately and treat effectively. Often times, we only refer to sub-specialists once treatments fail or at the request of patients themselves. This is where you can use my sub-specialty services on behalf of your patients to:

• expand your differential diagnosis and confirm diagnosis 
• review therapeutic plan tailored to your patient needs and co-morbidities
• review and expand current work up
• discuss interpretation of work up such as genetic results in the context of  autoinflammatory and autoimmune syndromes
• get referrals to leading expert physicians knowledgeable to look for specific signs in the recommended work up
•  connect patients to clinical trials