Author Affiliation: Dr Goldring is Associate Professor of Medicine, Harvard Medical School, and Chief of Rheumatology, Beth Israel Deaconess Medical Center and New England Baptist Hospital, Boston, Mass.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR PARKER: Mrs J is a 55-year-old woman with
moderately severe rheumatoid arthritis (RA) that was diagnosed in 1985 after
several years of intermittently swollen and painful joints. Due to her illness,
she retired from her profession as a restaurateur. She still experiences daily
pain in her joints and is facing surgery on her feet. She is married, lives
in the Boston suburbs, and has managed care insurance.
Mrs J first noted pain and swelling in her wrists and knees. Later,
she experienced morning stiffness, pain, and disfigurement of her hands and
feet. After years of symptoms, she was referred to a rheumatologist who made
the diagnosis of RA. She did not have adequate clinical responses to oral
or intramuscular gold, methotrexate, penicillamine, hydroxychloroquine sulfate,
or cyclosporine, mostly because of adverse effects. She took minocycline for
3 months, allowing her to taper her prednisone dosage, but developed yeast
infections. Mrs J's arthritis responds "magically" to prednisone, but she
dislikes the adverse effects, including cushingoid appearance, weight gain,
and diabetes. She describes feeling "run-down" when she tries to taper the
Goldring SR. A 55-Year-Old Woman With Rheumatoid Arthritis. JAMA. 2000;283(4):524-531. doi:10.1001/jama.283.4.524