Ania Foerste has always lived an active life. A long-distance cyclist who owned and ran not one, but two businesses-a catering company and a landscape design business-she spent long days on her feet, embracing a fast-paced lifestyle near her home in Plymouth, Massachusetts.
When she entered her 40s, something began to change. What started as unusual pain and fatigue soon became debilitating. Simple daily tasks that once felt routine suddenly became incredibly difficult. Ania knew this wasn't the normal aches and pains that come with life. However, her primary care provider (PCP) at the time disagreed.
"I was first told it was nothing more than inflammation, and that inflammation can look different for everyone. They suggested I start using a cane," she says. "But the pain was disrupting my life so much that I knew I needed a second opinion. I went to see an orthopedist, who told me the problem was surgical and that I would need both knees replaced."
Still, Ania didn't believe the issue was limited to her knees, and she wasn't convinced that inflammation alone could explain what she was experiencing. Her body was telling her something bigger was going on.
By this point, Ania says she no longer felt like herself. Even with a cane, simply getting to and from the car had become a major challenge. Tearfully, she asked the orthopedist for a recommendation-any physician who might be able to help her find a nonsurgical answer.
After hearing Ania’s concerns, the orthopedist printed the photo and contact information for a provider she believed could help—Boston Medical Center’s Chief of Rheumatology, Tuhina Neogi, MD, PhD.
Feeling Heard for the First Time
Ania needed a doctor who would listen to her, and that is what she found with Dr. Neogi.
In their first appointment, Dr. Neogi asked more questions and ordered more tests than any provider Ania had seen previously. She took a holistic approach to Ania's care, carefully considering her full medical history and symptoms.
"I remember telling Dr. Neogi that I was in my mid-40s and wondered if maybe it was just aging," Ania recalls. "She looked me in the eye and told me that this was not normal aging and that I was too young to feel like this."
That moment of validation meant a great deal to Ania.
“Unfortunately, it’s not uncommon for patients’ symptoms to be dismissed, especially when they don’t fit a clear pattern,” says Dr. Neogi. “And often it is disproportionately women and people from underrepresented backgrounds who experience those types of interactions.”
Ania’s previous experience was very much aligned with Dr. Neogi’s words.
"As a woman, sometimes in the medical world, you feel like you're not heard or your concerns are brushed off," she says. "Dr. Neogi is the first doctor in my life who truly hears me."
Finding a Proper Diagnosis
Through careful testing and evaluation, Dr. Neogi determined that Ania was living with psoriatic arthritis (PsA).
"Ms. Foerste had classic symptoms of joint inflammation, along with physical exam findings of swelling," Dr. Neogi reflects. "The pattern of joint involvement, combined with her longstanding psoriatic skin lesions, was consistent with psoriatic arthritis, but we conducted a thorough workup to evaluate a broad range of possibilities."
PsA is a chronic inflammatory arthritis that can cause joint pain, swelling, stiffness, and fatigue, and is often, but not always, accompanied by psoriasis. The condition can look very different from person to person. In some cases, there are visible signs, such as skin rashes or nail changes.
In other cases, when there are no outward signs like skin lesions, diagnosis can be more difficult if those clues aren’t recognized. Even when psoriasis is present, it can still be missed, making PsA an “invisible illness” that is often challenging to diagnose.
"I've actually had psoriasis my whole life and never realized it could lead to something else," Ania shares. "Looking back, it was clearly a slow progression where I felt more fatigue and discomfort until eventually my whole body was in chronic pain."
A Whole-Body Approach to Treatment
Dr. Neogi began treatment immediately and put Ania on a short course of steroids to help provide rapid relief to her joints and alleviate swelling. Through additional testing, they ruled out other potential diagnoses and identified safe, long-term treatment options. She also approached Ania’s condition from a whole-body perspective, connecting her with a dermatologist and a digestive specialist.
Finding the right long-term treatment took time. Ania first tried oral medications commonly used to treat inflammation, including methotrexate. When those were not enough to control her symptoms, she moved to injectable medications and eventually biologic therapies.
“We have to work together to find the right combination for each individual,” says Dr. Neogi. “That means considering how well the treatment works, potential side effects, and how easy it is to take consistently.”
Dr. Neogi carefully monitored Ania’s progress with regular appointments and bloodwork while adjusting her treatment plan, incorporating Ania’s nutrition, stress levels, physical activity, and overall health, not just medication.
Ania says the entire rheumatology team helped her navigate the treatment process, especially when she began using injectable medications, which initially felt intimidating. Nurses and medical assistants guided her through the process, answering questions, returning calls quickly when she had concerns, and even bringing her into the clinic to administer injections while she learned.
"They treated me so gently," Ania says. "It can be a lonely journey, but I truly enjoy coming to my appointments. I feel so well cared for that it almost feels like visiting a spa."
Building a Care Team at BMC
Ania has now been seeing Dr. Neogi for nearly four years, scheduling appointments every three months. While Boston Medical Center is not exactly around the corner from her home in Plymouth, she says the care she receives makes the trip worthwhile.
Over time, she has moved nearly all of her medical care to BMC. What began as a visit to rheumatology has grown into a broader network of care that now includes her PCP, podiatrist, pulmonologist, and digestive specialist.
Today, Ania is feeling stronger and slowly returning to activities she once thought might be lost.
"I've been able to get back on my bike, which is wonderful," she says. "I've had to tone down my lifestyle somewhat, but getting back on the bike feels great."
Looking back, Ania says she ignored many of her early symptoms because she had spent much of her life caring for others. Like many people living with chronic conditions, she brushed off fatigue and discomfort for years before realizing something more serious was happening.
For others experiencing symptoms that may not have an obvious explanation, she offers simple advice: “Track your symptoms, trust your intuition, and find a doctor who takes the time to listen.”