The most common symptoms of Dermatomyositis include:

• Skin changes.A violet-colored or dusky red rash develops, most commonly on your face and eyelids and on knuckles, elbows, knees, chest and back. The rash, which can be itchy and painful, is often the first sign of dermatomyositis.

• Muscle weakness.Progressive muscle weakness involves the muscles closest to the trunk, such as those in your hips, thighs, shoulders, upper arms and neck. The weakness affects both the left and right sides of your body, and tends to gradually worsen.

If your doctor suspects dermatomyositis, they might suggest some of the following tests:

• Blood analysis
• Chest X-ray
• Electromyography(Muscle is measured in a relax or tighten activity.)
• MRI
• Skin or muscle biopsy

There is currently no cure for Dermatomyositis, however, treatment can improve your skin and your muscle strength and function. The earlier treatment is started in the course of Dermatomyositis, the more effective it is.

If your medical provider orders biologic injections or infusions, AZIV can provide the following medications in a convenient and comfortable setting for patients seeking treatment for Dermatomyositis:

• Immunoglobulin Infusion Therapy IVIG

• Remicade

• Infliximab (Remicade, Inflectra, Renflexis)

• Xolair
• Stelara

Hidradenitis Suppurativa (HS) (hi-drad-uh-NIE-tis sup-yoo-ruh-TIE-vuh) is a chronic skin disease. It can occur in one or multiple areas of your body. The condition causes small, painful lumps, boils or abscesses to form under the skin. The lesions can break open, or tunnels can form under the skin. The condition mostly affects areas where the skin rubs together, such as the armpits, groin, buttocks and breasts. It causes long-term skin inflammation and can be painful.
Hidradenitis suppurativa most commonly occurs in women between the ages of 18 and 29. It can persist for many years and worsen over time. This condition has serious effects on your daily life and emotional well-being. Early detection is key to getting effective treatment. There are treatment options that can help manage symptoms and prevent complications.The exact cause of hidradenitis suppurativa is unknown. It develops when hair follicles in the skin become blocked. It is not caused by an infection or being unclean, and it can’t be spread to others.

There are no laboratory tests used to diagnosis this condition.  Typically, a diagnosis is obtained with a thorough patient history and physical exam. If there is pus or drainage present, a culture of the fluid may be done to rule out other conditions, such as an infection.

There are a variety of medications available to help manage your symptoms depending on the severity of the condition.

AZIV Infusion provides the following biological therapies and infusions in a convenient and comfortable setting for patients seeking treatment for Hidradenitis Suppurativa:

• Infliximab (Remicade, Inflectra, Renflexis)
• Solu-Medrol

Multiple sclerosis symptoms differ greatly and often affect movement:

• Numbness or muscle weakness in one or more limbs that typically occurs on one side of your body at a time, or the hands, legs and trunk
• Tingling and burning sensations, numbness, and chronic pain with certain neck movements, especially bending the neck forward
• Tremor, lack of coordination or unsteady balance
• Problems with sexual, bowel and bladder function
• Slurred speech
• Fatigue
• Dizziness

Vision problems are also common, including:

• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Blurry vision

There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms. The assessment includes neurological findings, clinical observation, results of Magnetic Resonance Imaging (presence of areas of demyelination in the CNS), spinal fluid examination (presence of oligoclonal bands and/or elevated IgG index). Your doctor may include an evoked potential test which uses a visual stimuli or electrical stimuli, in which you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms.

There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary. However, a number of medications can be used to treat the disease symptoms, including but not limited to:

Corticosteroids

Plasma exchange (plasmapheresis)

Your doctor may order a more advanced therapy of biologic injections or infusions. AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Multiple Sclerosis:

• Tysabri
• Ocrevus
• Solu-Medrol

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. The most common symptoms are diarrhea with blood or pus, and abdominal discomfort. It often begins gradually and can become worse over time, though there may be periods of remission that can last for weeks or years.

Other symptoms include:

• Rectal pain
• Rectal bleeding — passing small amount of blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever

To confirm a diagnosis of Ulcerative Colitis, your medical professional may request one or more of the following tests and procedures:

• Blood tests
• Stool sample
• Colonoscopy
• Flexible sigmoidoscopy. To examine the last portion of your colon.
• X-ray
• CT scan
• Computerized Tomography (CT) enterography and magnetic resonance imaging (MRI) enterography.Used to evaluate bowel wall features of both upper and lower gastro-intestinal tract

Most individuals with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods of remission. Treatment usually involves drug therapy including biologic injections and infusions or surgery.

The drugs that work well for some people may not work for others, so it may take time to find the medication that you are most respond.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Ulcerative Colitis:

• Remicade
• Cimzia
• Entyvio

Rheumatoid Arthritis is a chronic disease characterized by periods of disease flares and remissions. Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. Rheumatoid arthritis symptoms vary in severity and include:

• Joint pain, such as in the joints of the feet, hands, and knees
• Swollen joints
• Fever
• Loss of range of motion
• Tender joints,
• Loss of joint function,
• Joint stiffness – worsens after inactivity
• Fatigue
• Rheumatoid nodules
• Anemia
• Joint warmth
• Joint deformity

About 40 percent of the people who have rheumatoid arthritis also experience symptoms that don’t involve the joints. Rheumatoid arthritis can affect many body systems including:

• Skin
• Eyes
• Lungs
• Heart
• Kidneys
• Salivary glands
• Nerve tissue
• Bone marrow
• Blood vessels

Rheumatoid Arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.

During the physical exam, your doctor will check your joints for swelling, redness and warmth. Reflexes and muscle strength are also evaluated.

The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options, severe rheumatoid arthritis can still cause physical disabilities. Treatment or medications selection will depend on the severity of your symptoms and how long you’ve had Rheumatoid Arthritis. Options might include

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Steroids
• Disease-modifying antirheumatic drugs (DMARDs).

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Rheumatoid Arthritis:

• Remicade
• Cimzia
• Rituxan
• Orencia
• Actemra
• Simponi Aria

Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes. Those with neuropathy often describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition.

Every nerve in the peripheral system has a specific function; therefore, symptoms depend on the type of nerves affected. Nerves are classified as follows:

• Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin
• Motor nerves that control muscle movement
• Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder

Symptoms of peripheral neuropathy include:

• Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
• Sharp, jabbing, throbbing or burning pain
• Extreme sensitivity to touch
• Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
• Lack of coordination and falling
• Muscle weakness
• Feeling as if you’re wearing gloves or socks when you’re not

If autonomic nerves are affected, symptoms might include:

• Heat intolerance
• Excessive sweating or not being able to sweat
• Bowel, bladder or digestive problems
• Changes in blood pressure, causing dizziness or lightheadedness

Peripheral neuropathy has many potential causes, so doctors are sometimes unable to pinpoint the exact cause of an acquired neuropathy. The diagnosis of neuropathy may include a physical exam, blood tests, imaging tests, nerve function test and a nerve and/or skin biopsy.

The treatment goal of neuropathy is to manage the condition causing your neuropathy and to relieve symptoms.

Medications can reduce the pain of peripheral neuropathy.

• Pain relievers
• Anti-seizure medications
• Topical treatments
• Antidepressant
   

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Neuropathy:

• Immunoglobulin Infusion Therapy IVIG

Guillain-Barre Syndrome often begins with tingling and weakness starting in your feet and legs and spreading to your upper body and arms. In nearly half of those with GBS symptoms begin in the arms or face.

Additional Guillain-Barre Syndrome symptoms may include:

• Prickling, pins and needles sensations in your fingers, toes, ankles or wrists
• Weakness in your legs that spreads to your upper body
• Unsteady walking
• Difficulty with eye or facial movements, including speaking, chewing or swallowing
• Severe pain that may feel achy or cramp like
• Difficulty with bladder control or bowel function
• Rapid heart rate
• Low or high blood pressure
• Difficulty breathing

The exact cause of Guillain-Barre Syndrome is unknown. It is often preceded by an infectious illness such as a respiratory infection or the stomach flu. Guillain-Barre Syndrome can be difficult to diagnose in its earliest stages. Its signs and symptoms are similar to those of other neurological disorders and may vary from person to person.

In addition to reviewing medical history and completing a thorough physical examination. Your doctor may order the following tests:

• Spinal tap (lumbar puncture)
• Electromyography to measure nerve activity
• Nerve conduction studies to measure the speed of nerve signals

• There’s no known cure for Guillain-Barre Syndrome, but several treatments can ease symptoms and reduce the duration of the illness. Most people recover from Guillain-Barre Syndrome, though some may experience lingering effects.AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Guillain-Barré Syndrome:
• Immunoglobulin Infusion Therapy IVIG

Symptoms of Crohn’s Disease vary depending on the severity of inflammation and where it occurs. Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission.

The most common symptoms are diarrhea, cramping and pain in the abdomen, fatigue and blood in your stool. A reduced appetite typically leads to unplanned weight loss. Symptoms often begin gradually and worsen over time, though there may be periods of remission that last for weeks or years.

The treatment goal of Inflammatory Bowel Disease is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. Although living with IBD can be discouraging, research is ongoing, and the outlook is improving.

Surgery for Crohn’s disease. Up to one-half of people with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Crohn’s Disease:

• Remicade
• Cimzia
• Entyvio
• Stelara

Psoriasis is a chronic skin condition caused by an overactive immune system. Symptoms include flaking, inflammation, and thick, white, silvery, or red patches of skin. Psoriasis treatments include steroid creams, occlusion, light therapy and oral medications, such as biologics.

No one knows the exact cause of psoriasis, but experts believe that it’s a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Some things that can trigger outbreaks are:

• Cuts, scrapes, or surgery
• Emotional stress
• Strep infections

• Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things.
  AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Psoriasis:
  • Intravenous Immunoglobulin
  • Remicade
  • Inflectra
  • Renflexis
  • Xolair
  • STELARA

Can occur at any age, but it’s most often seen in people who are middle-aged or older. There is no known cause of the condition, but it is not contagious. Common symptoms include:

• painful blisters that start in the mouth or skin areas
• skin blisters near the surface of the skin that come and go
• oozing, crusting, or peeling at the blister site

• AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Pemphigus Vulgaris:
  • Intravenous Immunoglobulin
  • Remicade
  • Infliximab (Remicade, Inflectra, Renflexis)
  • Xolair
  • Stelara

People who have Paget’s disease of bone typically have no symptoms. When symptoms do occur, the most common complaint is bone pain.

Because this disease causes your body to generate new bone faster than normal, the rapid remodeling produces bone that’s softer and weaker than normal bone, which can lead to bone pain, deformities and fractures.

The disease might affect only one or two areas of your body or might be widespread. Enlarged and misshapen bones can put extra stress on nearby joints, which may cause further pain and complications. Symptoms, depend on the affected part of your body.

• Pelvis. Paget’s disease of bone in the pelvis can cause hip pain.
• Skull. An overgrowth of bone in the skull can cause hearing loss or headaches.
• Spine. When the spine is affected nerve roots can become compressed. This can cause pain, tingling and numbness in an arm or leg.
• Leg. As the bones weaken, they may bend — causing you to become bowlegged.

The cause of Paget’s disease of bone is unknown. Scientists suspect a combination of environmental and genetic factors contribute to the disease. Several genes appear to be linked to getting the disease.

In addition to a physical exam, X-rays, and blood tests can help confirm the diagnosis of Paget’s disease of bone. X-rays and bone scan may reveal changes in the bones. While, those with Paget’s disease of bone usually have elevated levels of alkaline phosphatase in their blood, which can be discovered by a blood test.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Paget’s disease:

• Reclast
• Prolia
• Boniva

Psoriatic arthritis shares many symptoms with several other arthritic conditions, such as ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn’s disease and ulcerative colitis. Psoriatic arthritis presents as red patches of skin topped with silvery scales and additional symptoms include:

• Low back pain
• Conjunctivitis
• Reduced range of motion
• Swollen joints
• Nail pitting
• Joint pain and morning stiffness
• Foot pain
• Fatigue

Psoriatic arthritis is a diagnosis made mainly on clinical evaluation and based on the finding of psoriasis along with the typical inflammatory arthritis of the spine and/or other joints. There is no laboratory test to diagnose psoriatic arthritis. Some blood tests may confirm an abnormal elevated result and merely reflect presence of inflammation in the joints and other organs of the body. When one or two large joints (such a knees) are inflamed, arthrocentesis can be performed. This is an office procedure whereby a sterile needle is used to withdraw fluid from the inflamed joints. The fluid is then analyzed for inflammation. X-rays may show changes of cartilage or bone injury indicative of arthritis of the spine, sacroiliac joints, and/or joints of the hands. The blood test for the genetic marker HLA-B27, is often performed. This marker can be found in over 50% of patients with psoriatic arthritis who have spine inflammation.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Psoriatic Arthritis:

• Remicade
• Cimzia

Gout signs and symptoms almost always occur suddenly, and often at night. Attacks often occur as severe flare-ups typically in the feet and ankles and include:

• Intense joint pain
• Lingering discomfort and selling
• Inflammation and redness
• Limited range of motion.

Early in the course of this disease, flare-ups occur infrequently, last a week or so, and resolve on their own or with the help of medications that fight inflammation.

Over time, attacks become more frequent, last longer and involve an increasing number of joints. Eventually, if not controlled, gout sufferers may develop persistent joint pain, swelling, deformity and disability. If Gout goes untreated it can lead to worsening pain and joint damage.

During symptom-free periods, dietary guidelines may help protect against future gout attacks:

• Drink plenty of fluids
• Limit or avoid alcohol
• Get your protein from low-fat dairy products
• Limit your intake of meat, fish and poultry
• Maintain a desirable body weight
• Joint fluid test
• Blood test
• X-ray imaging
• Ultrasound

If you experience several gout attacks each year, or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s level of uric acid may be recommended. Options include:

• Medications that block uric acid production.
• Medication that improves uric acid removal.

• Krystexxa

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
• Skin lesions that appear or worsen with sun exposure (photosensitivity)
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud’s phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger it. The cause of lupus in most cases, however, is unknown. Some potential triggers include:

• Sunlight
• Infections
• Medications Lupus can be triggered by certain types of blood pressure medications, anti-seizure medications and antibiotics.

Treatment for lupus depends on your signs and symptoms. Medications most commonly used to control lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Antimalarial drugs
• Corticosteroids

If your physician or medical professional determine you would benefit from biologic injections and infusions, AZIV Infusion provides the following medications in a convenient and comfortable setting for patients seeking treatment for Lupus:

• Benlysta
• Intravenous Immunoglobulin
• Solu-Medrol

• Sores in the mouth and/or genital area that keep coming back
• Skin and joint pain
• Inflammation in the eyes

The brain, nerves, intestinal tract, and kidneys can also be involved.

There is no single laboratory test that can diagnose Vasculitis and Behçet’s disease. The diagnosis is primarily based on signs and symptoms. Nearly everyone with this condition develops mouth sores that recur at least three times in 12 months.

In order to make a clear diagnosis, it is necessary to rule out other illnesses that may also produce mouth sores and imitate the disease, such as systemic lupus, Crohn’s disease (an inflammatory condition of the intestines) and other forms of vasculitis. HLA B 51 is a genetic marker that can sometime be present in patients with Behçet’s syndrome.

Additional testing can be directed by a rheumatologist, and depending on pretest probability might include:

• ANA (Anti-nuclear antibodies)     
• Complement levels
• ESR
• CRP
• ANCA
• EMG/ NCS (electromyography/nerve conduction studies),
• Imaging including MRI/MRA or ultrasound
• Arteriography
• Tissue biopsy

The goal of treatment is to induce remission, to minimize drug toxicity and to monitor for signs of recurrence.

Different drugs are used to treat Vasculitis and Behçet’s disease, depending on the severity of the illness as well as what organs are affected:

Topical or Oral medications might include:

• Corticosteroids, such as prednisone, are the main treatment. These drugs suppress inflammation and immune function.
• Colchicine (Colcrys) may help with mouth and genital sores.
• Other drugs that suppress the immune system, such as: methotrexate (Trexall, Rasuvo), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan, Neosar); and anti-TNF biologics, such as infliximab (Remicade) and etanercept (Enbrel), are useful in more severe cases.
• Recently, Apremilast (Otezla), an oral medication (taken by mouth), was found to be effective in controlling mouth ulcers in Behçet’s disease.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Vasculitis and Behçet’s disease, including:

• Rituxan
• Solu-Medrol

Inflammatory myositis is more common in African-Americans compared to Caucasians and in woman as compared to men. Polymyositis primarily affects adults in their 30’s to 50’s. Dermatomyositis commonly affects children ages 5-15 and adults ages 45-65. Myositis can occur in combination with other autoimmune diseases. The exact cause is unknown, but we do know that it is an autoimmune disease (the body’s own immune system attacks the muscles) and in some cases the skin. Inclusion body myositis is most common after age 50. General symptoms of chronic inflammatory myopathy. The inflammatory myopathies are a group of diseases, with no known cause, that involve chronic muscle inflammation accompanied by muscle weakness.

Additional information on inflammatory myositis can be found at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Inflammatory-Myopathies

Symptoms of myositis may include:

• Trouble rising from a chair
• Difficulty climbing stairs or lifting arms
• Tired feeling after standing or walking
• Trouble swallowing or breathing
• muscle pain and soreness that does not resolve after a few weeks
• Known elevations in muscle enzymes by blood tests (CPK or aldolase)

Although the inflammatory myopathies affect about 50,000 Americans, often they are not diagnosed correctly.  In part, because patients with autoimmune myopathies have many of the same symptoms as those with inclusion body myositis, toxic myopathy, or muscular dystrophies, which are inherited forms of muscle disease.

Diagnosis includes a skilled clinical assessment, evaluating symptoms already discussed (e.g. how fast are the symptoms progressing), physical exam; however, laboratory confirmation of the diagnosis is required in most cases. The benchmark confirmation is muscle biopsy. Electromyography, estimation of SCK, and detection of myositis specific antibodies may be helpful. Conceivably, a patient with all of the classical clinical features of DM, elevation of the SCK, and typical neurophysiological changes does not need a confirmatory muscle biopsy, but overall few cases of suspected myositis should escape biopsy. If management difficulties arise, there is often regret if a biopsy was not performed before initiation of treatment.

The initial treatment for inflammatory myositis is steroids taken by mouth and sometimes intravenously, depending on how severe symptoms are at diagnosis. No other medication works as quickly. The eventual goal is to taper the steroids slowly and substitute a medication that is safer to take in the long term such as mycophenolate mofetil or azathioprine.

In severe cases of myositis, especially when the muscles used for swallowing are impacted, we sometimes use intravenous immunoglobulin, or IVIG, a medication given monthly by infusion.

Physical therapy is also an important part of myositis treatment to help patients regain strength.

AZIV Infusion provides the following biologic injections and infusions in a convenient and comfortable setting for patients seeking treatment for Inflammatory Myositis:

• Rituxan
• Intravenous Immunoglobulin