Wait, you want me to make sure you get what?
Case 3
It started out like any other Tuesday morning. One of our rheumatologists was seeing a 45-year-old woman who was new to the practice. When entering the room, she found this woman crying and sitting in the chair of the examining room on a cushion she had brought from home. She reported having been in a car accident six years prior and had suffered with lower back pain and radiculopathy ever since. She had never had any back, neck or sacroiliac pain prior to that time. She had no history of psoriasis, uveitis or inflammatory bowel disease. There was no morning stiffness, and pain was exacerbated by physical activity and relieved by rest. She got no relief from large doses of non-steroidal anti-inflammatory drugs. Her pain was clearly mechanical in nature. She had been through numerous rounds of physical therapy and epidural injections, and she was currently under the care of a pain management physician who was prescribing her large doses of narcotics for years.
For reasons unknown, her pain management doctor had recently given her a trial of prednisone, 20 mg daily. When she reported to him that her pain was much better while taking prednisone, he informed her that she must have inflammatory back pain, and that she should see a rheumatologist as soon as possible so she could be started on adalimumab.
Wait, you want me to do what?
Case 4
A patient was referred by a local hospital emergency room for follow-up and treatment of “clear-cut systemic lupus erythematosus (SLE).” After examining the patient, our rheumatologist called the referring physician to discuss the situation and was told to “use the steroid of your choice.”
Our rheumatologist explained that the patient did not have SLE. It did not seem to matter, and the choice of steroid was still up to us.
Wait, what?
Case 5
A patient in her 40s who suffers with rheumatoid arthritis and fibromyalgia has been followed by a single rheumatologist in our practice for a number of years. The patient had been working full time, but for the past year or more she has been unable to work as we attempted different treatments to improve her condition. Despite the time and effort we spent completing the Family and Medical Leave Act (FMLA) and short-term disability forms for her, she lost her job.
