Caring for patients with Parkinson’s disease: A practical guide for rheumatologists
Industry Buzz
A common mistake is to attribute all of symptoms from Parkinson's disease as age-related rather than seeking necessary specialist consultation for immediate recognition, diagnosis, and multidisciplinary management of what actually turns out to be Parkinson's disease.
—Jon Stewart Hao Dy, MD
Exercise is as essential as medicine for treating PD. Exercise can help delay PD's progression and improve daily quality of life. While all exercise is good, people with Parkinson's should seek out a PD-focused class that uses specific movements to combat the disease.
—Nina Mosier, MD
April marks Parkinson’s Awareness Month, a reminder that Parkinson’s rarely stays confined to neurology. Its early manifestations may surface in other specialties first—such as rheumatology, where musculoskeletal complaints, fatigue, and functional decline may be attributed to more familiar causes.
Jon Stewart Hao Dy, MD, a board-certified adult neurologist with special interests in neuroimmunology, neuromuscular diseases, and neurodegeneration, says, "A common mistake is to attribute all of symptoms from Parkinson's disease as age-related rather than seeking necessary specialist consultation for immediate recognition, diagnosis, and multidisciplinary management of what actually turns out to be Parkinson's disease.”
Rheumatologists belong in one of these groups of specialists. In rheumatology clinics, PD reshapes pain, stiffness, gait decline, fatigue, constipation, and lightheadedness.
Separate inflammatory pain from Parkinsonian pain
Musculoskeletal pain affects up to 75% of people with PD. Shoulder pain is common, and frozen shoulder or rotator cuff disease often enters the chart before tremor or bradykinesia draws attention.[]
A 2024 Danish cohort study found higher long-term PD risk after frozen shoulder diagnosis vs the general population.[] This fits a pattern many clinicians recognize: Shoulder complaints sometimes reflect early Parkinsonism rather than isolated regional disease.
A patient with inflammatory arthritis vs PD needs a careful distinction between synovitis, enthesitis, or structural joint disease and Parkinsonian rigidity or dystonia.[][]
Dr. Dy says, “Parkinsonism-related rigidity and slowness of movement can be initially mistaken as musculoskeletal strain/stiffness and even degenerative joint disease. In degenerative conditions of the joints, symptoms are usually symmetric, in contrast to Parkinson's disease, which presents with just symptoms more prominent on one side, with associated slowness of movement, reduced arm swing when walking.”
Give more attention to orthostasis and falls
Orthostatic hypotension is common in PD and often silent. In a 2024 cohort study, 35.8% of patients met criteria for orthostatic hypotension, and the bedside sit-to-stand test missed many cases. Orthostasis tracked with falls, lower fluid intake, worse motor burden, and more functional disability.[]
Those findings matter in rheumatology because opioids, sedatives, anticholinergic drugs, and long clinic days add strain to a patient who already stands on a narrow physiologic margin.
When a patient reports fatigue, “weakness,” or dizziness after a medication change, standing blood pressure and medication review deserve equal weight alongside disease activity scoring.
The inflammation story around PD keeps growing
A 2022 meta-analysis found lower PD risk in people with RA, with a pooled relative risk of 0.74.[]
A 2025 retrospective cohort study of more than 2.1 million patients with autoimmune disease then found lower PD incidence among those treated with anti-TNF or anti-IL-17 therapy, with an adjusted incidence rate ratio of 0.77 overall and 0.64 for anti-IL-17 exposure. Those findings point toward shared immune biology.[]
Need for early referral
Discussing the common mistakes made by non-neurologists while caring for a PD patient, Ryan Van Wert, MD, board certified in internal medicine, critical care medicine, and pulmonology, and Clinical Associate Professor of Medicine at Stanford University, explains the following.
“There are two issues I frequently see," he says. "Lack of referral to a movement disorder clinic or specialist neurology care. Certainly there are access issues to this level of care, but it is important that patients are assessed.… Lack of a comprehensive exercise program, and really making sure the patient follows through. Support can be provided by providing a referral to PT, particularly neuroPT, which is covered by Medicare, and encouraging ongoing exercise.”
Physical activity and rehabilitation
Physical rehab is a cornerstone of Parkinson's treatment. As neurological physical therapist Jimmy Pang, PT/DPT, notes, “While abilities vary, most individuals benefit from appropriately dosed high-intensity training, which is strongly supported in the literature. Under-dosing therapy can limit meaningful functional gains and long-term outcomes."
Discussing the benefits of physical therapy, Nina Mosier, MD, a board-certified internist and co-founder of Power for Parkinson's, adds, “Exercise is as essential as medicine for treating PD. Exercise can help delay PD's progression and improve daily quality of life. While all exercise is good, people with Parkinson's should seek out a PD-focused class that uses specific movements to combat the disease.”
The best research-backed exercises for Parkinson’s disease are aerobic training, strength training, balance, and stretching exercises.[][]
Key Clinical Takeaways
Early PD can masquerade as rheum disease (eg, frozen shoulder, asymmetric stiffness). Unilateral symptoms + bradykinesia should trigger neuro eval.
Orthostatic hypotension is common (~36%) and underdetected; contributes to falls and fatigue. Check standing BP and review meds (opioids, anticholinergics) before attributing symptoms to disease activity.
Immune signaling may be protective: anti-TNF/IL-17 therapies linked to lower PD incidence. Reinforces overlap between inflammation and neurodegeneration—and may influence long-term risk discussions.