Problems in the Rheumatic Diseases

Lessons from Patients

Any physician travelling to other centres throughout the world must be struck by the similarity of the problems in diagnosis and management faced by fellow colleagues in rheumatology. Despite the international spread of journals and of standard textbooks, the same practical questions constantly appear - how do you manage the psychotic patient with cerebral lupus, or the patient with intractable polymyositis, or the rheumatoid patient who has failed on almost all known therapeutic agents. Is it worth differentiating various 'overlap' syndromes? How can one improve on the classification and treatment "i}f.vasculitis? Two questions - what is the patient telling us? and what can we do for the patient? are always central to the discussion. Although these high-minded ideals are often not fulfilled, frequently something new appears to come from individual case presentations. These cases, discussed at our weekly conferences, were contributed by a number of different staff members. Where possible, a standard format has been use in each case presentation and a comment added where indicated. A short list of relevant references has been included with each case. The aim of this book is to provide examples of these clinical problems and our own clinical approach to them - sometimes successfu~ sometimes not.