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Parker RA, Hartman EE. A 55-Year-Old Woman With Rheumatoid Arthritis, 1 Year Later. JAMA. 2000;284(12):1567. doi:10.1001/jama.284.12.1567
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
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.
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.
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.
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