A Hypothetical Case
In the next section of the talk, several speakers worked together to apply the guideline to a hypothetical patient’s case. The patient case was about a 35-year-old parent and small business owner with seropositive rheumatoid arthritis who has been started on treatment with methotrexate.
Dr. Barton
The team responsible for discussing this patient’s case included Jennifer Barton, MD, associate professor of medicine, Division of Arthritis and Rheumatic Diseases, Oregon Health Sciences University, Portland; Nancy Baker, OT, MPH, ScD, associate professor, Occupational Therapy, Tufts University, Medford, Mass.; Carol Oatis, PhD, PT, professor emerita, Arcadia University, Glenside, Pa.; and Kaleb Michaud, PhD, professor, Division of Rheumatology, and director of the Rheumatology Fellowship Research Program, University of Nebraska Medical Center, Omaha.
Patient Goals & Preferences
The panelists began by discussing how patient goals and preferences should be central in supplementing pharmacologic therapy with integrative treatments. For this patient, goals may include minimizing pain and maximizing function, especially concerning the ability to be productive at work and be able to engage in meaningful time spent with family and friends.
Dr. Barton noted that, based on the new ACR guideline, recommendations to follow a Mediterranean diet would be reasonable. This would, of course, have to take into account the patient’s access to healthy foods and budget for such dietary changes.
Dr. Oatis
Dr. Oatis went on to note that, for this patient and all other patients with rheumatoid arthritis, it is not only safe to exercise, but it is also strongly recommended to do so. On the theme of exercise, patients may ask, what if my joints hurt while engaging in exercise? Dr. Oatis preempted this consideration by explaining that guidance from a physical therapist and occupational therapist may be necessary to teach patients how to exercise safely without causing undue pain. Dr. Baker expanded on the subject of safe and effective exercise by describing such concepts as activity pacing, joint protection and ergonomic assessments.
In the Workplace
Dr. Baker
Dr. Baker went on to make specific note of the fact that many patients encounter difficulty managing their rheumatoid arthritis when they are at their place of work. This may relate to several factors, including the challenge of being able to modify work activities and/or the physical work environment in a way that would allow for decreased pain and increased function for patients.
