Areas of Rheumatology Expertise
Donald E. Thomas, Jr., MD, FACP, FACR, RhMSUS provides rheumatology expert witness case review across a broad range of rheumatologic, autoimmune, inflammatory, and musculoskeletal conditions, including lupus, Sjögren's disease, rheumatoid arthritis, vasculitis, scleroderma, myositis, fibromyalgia, hypermobile Ehlers-Danlos syndrome, gout, osteoarthritis, and spinal disorders. His opinions draw on more than 35 years of clinical rheumatology experience and are guided by the medical record, the clinical context, and accepted standards of rheumatology practice.
Dr. Thomas reviews matters for both plaintiff and defense attorneys. For how these reviews are performed, including record review, causation and standard of care analysis, written reports, and testimony, see his expert witness services.
Lupus and Sjögren's Disease
Lupus and Sjögren's disease are among Dr. Thomas' deepest areas of expertise. He is the author of The Lupus Encyclopedia and Lupus: The Essential Guide, and these conditions are central to his clinical practice. Systemic lupus erythematosus (SLE) can affect the joints, skin, kidneys, lungs, heart, blood, and nervous system, which makes questions of diagnosis, causation, and disability unusually complex. Medical-legal matters involving lupus and Sjögren's disease often raise issues such as:
Delayed diagnosis or misdiagnosis, since early symptoms are frequently nonspecific
Interpretation of ANA, anti-dsDNA, complement levels, SSA/Ro, SSB/La antibodies, and related laboratory testing
Whether trauma, illness, medication exposure, or delayed treatment aggravated disease activity
Lupus nephritis, organ involvement, disease flares, prognosis, and long-term disability
Medication selection and monitoring in immunosuppressive therapy
Rheumatoid Arthritis and Inflammatory Arthritis
Dr. Thomas reviews cases involving rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis and axial spondyloarthritis, reactive arthritis, and other forms of inflammatory arthritis. Typical medical-legal questions in this area include:
Delayed diagnosis, failure to escalate therapy, or inadequate treatment leading to progressive joint damage
Interpretation of rheumatoid factor, anti-CCP, and inflammatory markers, including seronegative disease
Distinguishing inflammatory arthritis from degenerative, post-traumatic, or chronic pain conditions
Appropriateness of disease-modifying and biologic therapy, and the monitoring of that therapy
Functional impairment, work capacity, and future care needs
Monitoring for medication toxicity, infection risk, and treatment response
Scleroderma, Myositis, and Connective Tissue Disease
Dr. Thomas handles case reviews for systemic sclerosis (scleroderma), dermatomyositis, polymyositis and other inflammatory muscle disease, mixed connective tissue disease, overlap syndromes, and Raynaud's phenomenon. These uncommon, multisystem diseases often raise questions involving:
Diagnostic accuracy and the time to diagnosis in rare, multi-system illness
Interpretation of autoantibody panels and muscle-related laboratory testing
Organ involvement, disease progression, prognosis, and future care needs
Whether evaluation and referral were consistent with accepted rheumatology practice
Vasculitis, Giant Cell Arteritis, and Polymyalgia Rheumatica
Dr. Thomas provides expert analysis of systemic vasculitis, including giant cell arteritis (temporal arteritis), as well as polymyalgia rheumatica and related inflammatory conditions. Delayed diagnosis of giant cell arteritis is a frequent subject of medical-legal review because untreated disease can cause permanent vision loss. Related questions in this area include:
Recognition and urgent treatment of suspected giant cell arteritis
Differentiation of polymyalgia rheumatica from giant cell arteritis and from other inflammatory conditions
Corticosteroid dosing, tapering, and complication monitoring
Causation, prognosis, and residual impairment after vasculitis
Fibromyalgia and Hypermobile Ehlers-Danlos Syndrome
Dr. Thomas evaluates matters involving fibromyalgia, hypermobile Ehlers-Danlos syndrome, and related hypermobility and chronic pain questions. These cases frequently involve:
Whether fibromyalgia, hypermobility-related pain, or a chronic widespread pain condition was caused or aggravated by trauma, including motor vehicle collisions
Distinguishing fibromyalgia from inflammatory, autoimmune, degenerative, and traumatic conditions
Hypermobility assessment and its relationship to joint symptoms and function
Disability, functional impairment, and future care in chronic pain conditions
Distinguishing preexisting symptoms from new or worsened post-injury complaints
Osteoarthritis, Post-Traumatic Arthritis, and Degenerative Spine Conditions
Dr. Thomas renders expert opinions on osteoarthritis, post-traumatic arthritis, degenerative disc disease, spinal stenosis, and other spinal and musculoskeletal disorders. Common questions include:
Whether joint or spine findings reflect preexisting degeneration, trauma, or an aggravation of preexisting disease
Differentiating inflammatory, degenerative, traumatic, and mechanical contributors to pain and impairment
The relationship between an injury, symptom onset, and imaging findings
Interpretation of X-ray, MRI, and musculoskeletal imaging in context
Functional limitations, work capacity, prognosis, and future care
Gout, Crystalline Arthritis, and Osteoporosis
Dr. Thomas takes on cases involving gout, pseudogout/calcium pyrophosphate deposition disease, and osteoporosis. Typical issues include:
Diagnosis and management of gout, including uric acid interpretation and treatment monitoring
Differentiating crystalline arthritis from infection and from other inflammatory arthritis
Osteoporosis evaluation, fracture-related questions, and bone loss associated with long-term corticosteroid therapy
Medication Toxicity and Treatment Monitoring
Dr. Thomas reviews cases involving complications and monitoring of medications commonly used in rheumatology, including corticosteroids, methotrexate, hydroxychloroquine, biologic agents, and other immunosuppressive therapies. Questions in this area often include whether medication selection was appropriate for the condition, whether recommended monitoring was performed, and whether complications were recognized and addressed in a timely manner. Medication-related questions may include steroid complications, methotrexate monitoring, hydroxychloroquine dosing and eye-screening issues, biologic safety and infection risk, immunosuppressive therapy monitoring, and recognition of medication toxicity.
Musculoskeletal Ultrasound Interpretation
Dr. Thomas is certified in musculoskeletal ultrasound through the American College of Rheumatology (RhMSUS). He reviews questions on the appropriate use and interpretation of musculoskeletal ultrasound for the diagnosis and management of inflammatory arthritis, crystal arthritis, joint effusions, tendon disease, and soft-tissue disease.
Medical-Legal Questions Addressed Across These Conditions
Across all of the conditions above, Dr. Thomas addresses diagnosis and differential diagnosis, causation and aggravation of preexisting disease, standard of care, interpretation of rheumatology laboratory tests and imaging, disability and functional impairment, prognosis, and future care needs. These questions arise in medical malpractice, personal injury, disability, causation, aggravation, and medication-related matters. For a fuller description of case types and services, see the Expert Witness Services page.
Frequently Asked Questions
Which rheumatology conditions does Dr. Thomas review as an expert witness?
Dr. Thomas reviews lupus, Sjögren's disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, scleroderma, myositis, vasculitis, giant cell arteritis, polymyalgia rheumatica, fibromyalgia, hypermobile Ehlers-Danlos syndrome, osteoarthritis, post-traumatic arthritis, degenerative spine conditions, gout, pseudogout, osteoporosis, and medication toxicity and monitoring questions.
Can Dr. Thomas distinguish inflammatory arthritis from degenerative or trauma-related conditions?
Yes. Differentiating inflammatory, degenerative, traumatic, and chronic pain conditions is a core rheumatology skill and a frequent issue in personal injury and disability matters. Dr. Thomas addresses this through the clinical history, examination findings documented in the record, laboratory testing, and imaging.
Does Dr. Thomas review medication toxicity and monitoring cases?
Yes. He reviews complications and monitoring questions involving corticosteroids, methotrexate, hydroxychloroquine, biologic agents, and other immunosuppressive medications used in rheumatology, when the issues fall within his area of expertise and involve rheumatology standards of care.
Request a Rheumatology Case Review
To discuss a matter involving any of these conditions, request Dr. Thomas' CV, fee schedule, or a complimentary initial consultation. Attorney inquiries may call 301-842-7321.
Initial inquiries do not create a physician-patient relationship, attorney-client relationship, or expert witness retention. Please do not send protected health information, confidential medical records, or extensive case materials until secure transmission has been arranged and a conflict check is complete.