Charles M. Plotz

Rheumatoid arthritis. Guidelines for office management.

Since this chronic inflammatory disease is characterized by a combination of destruction and healing, a two-pronged approach to management that incorporates antiinflammatory drug therapy and physiotherapy is advised. More toxic drugs or even surgery may be tried in stepwise fashion if initial measures fail to relieve symptoms.

Mild disease in a highly motivated patient

Selected illustrative cases are reported, followed by “instant consultations” with appropriate specialists. The psychologic and socioeconomic effects of arthritis are inseparable from the direct physical effects of the disease. Even in mild disease a good deal of motivation is necessary to successful management. The best source of this stimulation is the patients personal physician.

severe disease complicated by osteoporosis

In this illustrative case, rheumatoid disease changed an active, self-supporting woman into a disabled, dependent and depressed person. When disease activity is continuous, early efforts to prevent severe deformity take on great urgency. It is also important to alleviate the psychosocial impact of the disease, which may well be more than even a highly motivated patient can handle alone.

Unremitting disease in a young mother.

In this case the psychosocial impact of arthritis was superimposed on an already precarious home environment. When the disease began, the patient was still a teen-ager and was pregnant. Three years later she was an abandoned wife, was unable fully to care for her baby or herself, and did not have enough money for food.