Rheumatology Services in Clovis & Fresno, CA
Many autoimmune and inflammatory conditions affect both the skin and the joints — and treating one without addressing the other often leaves patients with incomplete relief. At Dehesa Dermatology, our integrated rheumatology and dermatology team provides a truly comprehensive approach to autoimmune care that patients in Clovis, Fresno, and the greater Central Valley simply can’t find anywhere else in the region. Led by board-certified rheumatologist Dr. Milena Cavalcante, our rheumatology department works hand-in-hand with Dr. Dehesa’s dermatology expertise to deliver unified, whole-patient care under one roof.
What Is Rheumatology?
Rheumatology is the medical specialty focused on diagnosing and treating diseases of the joints, muscles, bones, and connective tissues — with a particular emphasis on autoimmune and inflammatory conditions. These diseases arise when the immune system malfunctions and begins attacking the body’s own tissues, causing widespread inflammation that can affect the joints, skin, kidneys, lungs, heart, and other organs.
The connection between rheumatology and dermatology is profound. Many of the most common rheumatologic conditions — psoriatic arthritis, lupus, dermatomyositis, scleroderma, and vasculitis — manifest prominently through the skin. In many cases, the skin findings are the first and most visible sign of an underlying systemic autoimmune disease. At Dehesa Dermatology, having both specialties working together means that patients get a more complete picture of their condition, more coordinated treatment, and better overall outcomes.
Conditions We Manage
Our rheumatology and dermatology team at Dehesa Dermatology evaluates and treats a wide spectrum of autoimmune and inflammatory conditions, including:
- Psoriatic Arthritis: Joint inflammation occurring in patients with psoriasis, causing pain, stiffness, and swelling in the fingers, toes, spine, and larger joints. Requires coordinated skin and joint management to prevent progressive joint damage.
- Systemic Lupus Erythematosus (SLE): A multisystem autoimmune disease that commonly presents with the classic butterfly rash on the face, along with joint pain, fatigue, kidney disease, and other systemic complications.
- Discoid Lupus Erythematosus (DLE): A chronic skin-limited form of lupus causing scarring, hyperpigmented plaques — most commonly on the face and scalp — that can result in permanent hair loss if not treated promptly.
- Dermatomyositis: An inflammatory muscle disease with distinctive skin findings including heliotrope rash around the eyes and Gottron’s papules on the knuckles. Requires close monitoring for associated internal malignancy.
- Scleroderma (Systemic Sclerosis): A connective tissue disease causing progressive hardening and thickening of the skin, along with internal organ involvement. Skin care and systemic management must be carefully integrated.
- Rheumatoid Arthritis with Skin Manifestations: Including rheumatoid nodules, vasculitis, and other cutaneous features that benefit from combined rheumatologic and dermatologic evaluation.
- Vasculitis: Inflammation of blood vessels presenting through the skin as purpura, ulcerations, livedo reticularis, or other lesions that require systemic evaluation and management.
- Sjögren’s Syndrome: An autoimmune condition causing dry eyes and dry mouth, often with associated skin dryness, rashes, and other dermatologic manifestations.
- Mixed Connective Tissue Disease: An overlap syndrome with features of lupus, scleroderma, and myositis requiring specialized multidisciplinary evaluation.
- Reactive Arthritis (formerly Reiter’s Syndrome): Joint inflammation following an infection, often accompanied by skin and eye findings.
Why Integrated Rheumatology-Dermatology Care Matters
Patients with autoimmune conditions frequently see multiple specialists at different offices — often struggling to coordinate care between a rheumatologist managing their joints and a dermatologist managing their skin. At Dehesa Dermatology, this fragmentation doesn’t exist. Dr. Cavalcante and Dr. Dehesa communicate directly and regularly, sharing patient records and treatment plans to ensure that every decision — whether it’s starting a biologic, adjusting immunosuppression, or initiating infusion therapy — is made with a complete picture of the patient’s overall health.
This integrated model also enables us to offer infusion-based biologics — including IV medications for psoriatic arthritis, lupus, and other autoimmune conditions — through our on-site infusion therapy center. Patients can receive their IV treatments in the same familiar clinical setting where they receive their dermatology and rheumatology care, with medical oversight throughout each session.
Signs You Should Seek Rheumatologic Evaluation
Consider scheduling an appointment at Dehesa Dermatology if you experience any of the following:
- Persistent joint pain, swelling, or morning stiffness lasting more than 6 weeks
- A skin rash that appears or worsens with sun exposure (photosensitive rash)
- Unexplained fatigue combined with joint or skin symptoms
- Hair loss combined with skin changes or joint complaints
- Raynaud’s phenomenon (color changes in the fingers with cold or stress)
- Muscle weakness with skin changes
- Dry eyes and dry mouth combined with joint or skin complaints
- A known autoimmune diagnosis that is not well-controlled
Frequently Asked Questions About Rheumatology
What makes Dehesa Dermatology’s rheumatology services unique?
Most patients with autoimmune conditions must coordinate care between a standalone rheumatologist and a separate dermatologist — often at different offices, with limited communication between providers. At Dehesa Dermatology, our board-certified rheumatologist Dr. Milena Cavalcante works directly alongside Dr. Dehesa in the same practice. This means integrated care, shared records, coordinated treatment decisions, and access to on-site infusion therapy — a level of multidisciplinary autoimmune care that is rare outside of academic medical centers.
What is the difference between rheumatoid arthritis and psoriatic arthritis?
Both are autoimmune inflammatory arthritis conditions, but they differ in important ways. Rheumatoid arthritis typically involves the small joints of the hands and feet symmetrically and is associated with specific antibodies (rheumatoid factor, anti-CCP). Psoriatic arthritis occurs in patients with psoriasis, can be asymmetric, often involves the spine and fingernails, and follows different inflammatory pathways — responding to different treatment targets. Accurate diagnosis through clinical evaluation and laboratory testing is essential for selecting the most effective treatment.
How are autoimmune conditions diagnosed at Dehesa Dermatology?
Diagnosis involves a combination of detailed clinical history, physical examination, skin biopsy when appropriate, and a targeted laboratory workup — including autoimmune antibody panels (ANA, anti-dsDNA, rheumatoid factor, anti-CCP, ANCA, and others), inflammatory markers, complete blood count, metabolic panel, and organ-specific tests based on the suspected diagnosis. Our team coordinates the workup efficiently, minimizing the need for multiple lab visits, and reviews all results with you in a thorough follow-up appointment.
Can rheumatologic conditions cause skin problems?
Absolutely — skin manifestations are among the most common and visible features of rheumatologic diseases. Lupus presents with a butterfly facial rash and photosensitivity. Dermatomyositis causes distinctive periorbital and knuckle rashes. Psoriatic arthritis is linked to psoriatic skin disease. Scleroderma causes skin thickening and hardening. Vasculitis produces purpura and skin ulcerations. Having a dermatologist involved in the evaluation of these skin findings is critical for accurate diagnosis and monitoring.
What treatment options are available for autoimmune conditions at your practice?
Our treatment options span a wide spectrum, from anti-inflammatory topicals and antimalarials (hydroxychloroquine) to methotrexate, mycophenolate, azathioprine, and the most advanced biologic and targeted synthetic therapies. For conditions requiring IV biologic therapy — such as infliximab for psoriatic arthritis or belimumab for lupus — our on-site infusion therapy center provides this service without requiring you to travel to a separate infusion facility.
Does Dehesa Dermatology accept new rheumatology patients from Fresno?
Yes. We actively welcome new rheumatology patients from Fresno, Clovis, Madera, and throughout the Central Valley. Access to integrated rheumatology and dermatology care in the same practice is rare in this region, and many patients travel from Fresno for precisely this reason. Our office at 978 N Temperance Ave in Clovis is conveniently accessible from Fresno via Highway 168. Call (559) 951-9000 to schedule your evaluation.
How do I know if my condition needs both rheumatology and dermatology care?
If you have been diagnosed with — or suspect — any condition that involves both skin and joint or connective tissue symptoms, you likely benefit from combined care. Common examples include psoriatic arthritis, lupus, dermatomyositis, scleroderma, and vasculitis. Rather than trying to figure out which specialist to see first, schedule a consultation at Dehesa Dermatology — our integrated team will evaluate your complete picture and develop a unified care plan that addresses all dimensions of your condition.