March 25, 1983

Treatment of Rheumatoid Arthritis-Reply

Author Affiliations

Hahnemann University School of Medicine Philadelphia

JAMA. 1983;249(12):1566. doi:10.1001/jama.1983.03330360020021

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In Reply.—  Primary care can be offered to individual patients by anyone, but the purpose of my editorial was to caution physicians not experienced in the use of immunosuppressive compounds alone or in combination from applying such dramatic treatments without benefit of consultation. I would hesitate to start such a treatment myself with one of my patients without discussing the problem with my colleagues, as one can be blinded by preconceived ideas and unwarranted self-confidence. I would urge any physician planning to repeat the Milwaukee treatment to do so only with a carefully constructed protocol in hand and with peer review to confirm the need for this approach in the particular patient. Rheumatologists, hematologists, and immunologists should be in a position to apply this treatment; I would hope that obstetricians, most pediatricians, and most internists would not do so. Board certification is irrelevant, in my opinion, as mostly the younger