Listening to the patient’s story, parsing through their symptoms, and carefully examining their joints and soft tissues is what sets our specialty apart. Sometimes, it may not be rocket science, but the end result, establishing a fairly accurate diagnosis and devising a treatment plan, is highly appreciated by patients. Examples: Ask my patient who was admitted to the intensive care unit (ICU) with a presumptive diagnosis of bacterial meningitis, a diagnosis that was discarded following a careful review of her cervical spine imaging studies, which demonstrated a linear stripe of calcification along the longus colli tendon. When have you ever witnessed an ICU patient being happily discharged home on naproxen? Or there is the story of my lovely immune-compromised patient with rheumatoid arthritis who is fighting an atypical mycobacterial infection using an array of antibiotics, including moxifloxacin. Several imaging studies and ophthalmology visits later, it became apparent that her new, persistent eye pain and ocular soreness were actually caused by a tendonitis afflicting her lateral rectus muscle insertion. Yes, fluoroquinolone antibiotics may not just harm the Achilles tendons. All of the body’s tendons can be in play.
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Explore This IssueSeptember 2015
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These are the things we learn in our discipline. After all, we are rheumatologists, the experts in making the mundane magnificent: one case of tendonitis at a time.
Simon M. Helfgott, MD, is associate professor of medicine in the Division of Rheumatology, Immunology and Allergy at Harvard Medical School in Boston.
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