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Goldring SR. A 55-year-old woman with rheumatoid arthritis.  JAMA.2000;283:524-531.Google Scholar
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Clinical Crossroads
September 27, 2000

A 55-Year-Old Woman With Rheumatoid Arthritis, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;284(12):1567. doi:10.1001/jama.284.12.1567

In April 1999, Steven R. Goldring, MD, discussed a 55-year-old woman with rheumatoid arthritis.1 The patient, Mrs J, who also has type 1 diabetes mellitus, retired from her profession as a restaurateur because of her painful and disabling joint symptoms. She had tried multiple medications unsuccessfully and was being treated with leflunomide and prednisone, 10 mg in the morning and 5 mg at night. Mrs J described difficulty opening jars and doors, but characterized herself as "a fighter." Dr Goldring gave an overview of rheumatoid arthritis and shared his insights regarding pathology, pathogenesis, and disease assessment and treatment strategies. He suggested that Mrs J might benefit from the addition of a second or even a third disease-modifying antirheumatic drug or perhaps a trial of etanercept. We asked the patient and her physician to comment on the year that has passed.

Mrs j, the patient

I underwent surgery on both feet, including a bunionectomy and straightening out of the toes. I'm full of pins and screws now. It took about 10 weeks to recover. On the positive side, I walk better, and I can wear different shoes. On the negative side, the toes are slowly turning out again. My hands are giving me a hard time and are more deformed, but my energy level is always good. For the arthritis, I am currently taking rofecoxib, methotrexate, and prednisone. I would still like to get off prednisone and insulin. I appreciate the input from all of my doctors—internist, diabetologist, and rheumatologist.

Dr c, the patient's internist

I haven't seen Mrs J in a while. I think she was a little disappointed by some of the new drugs she tried. After the surgeries on her feet, she became less active, and her blood sugars went up, but, overall, it seemed worthwhile for her. She is overdue for a physical, and I am going to contact her.

Goldring SR. A 55-year-old woman with rheumatoid arthritis.  JAMA.2000;283:524-531.Google Scholar