Professor Sterling G. West wrote ten golden rules for rheumatologists, noting that “nothing is absolute”, which is a conventional idea and should not be used as a law.
However, it makes sense to write it for patients. Too many patients are fooled by “miracle doctors” and “gurus” and are confused about whether they are sick or not, major or minor, so too many patients dwell on symptoms that do not need treatment at all, thinking they are still alive because of the gurus’ advice. They think they are still alive because they have been “enchanted” by the gurus. In fact, there are always discomforts of one kind or another, and not all symptoms need to be solved by the secret sauce. Take a look at these “golden rules” may help you to have some independent opinions when “listening” and “seeing a doctor”, and not be so easily fooled and intimidated.
The first rule is that a thorough medical history and physical examination with knowledge of the anatomy of the muscles and joints are very important for diagnosis. In any case, the doctor must personally examine the patient.
The guru of remote diagnosis from a distance has no idea whether you are sick or not.
Number two, do not easily request a test, including a blood draw or x-ray, unless you know why the test is being done or what you should do if the test comes back positive.
Indiscriminate testing is becoming another crooked trend in hospitals after indiscriminate prescribing.
Third, acute monoarthritis should be examined by pumping joint fluid to exclude “septic arthritis” and “crystal arthritis”.
When doctors say “arthritis”, they mean not only joint pain, but also swelling or local redness and heat of the joints, so “joint pain” is not the same as “arthritis”. Swelling also has specific manifestations, and it is too common for patients to judge swelling differently from their doctors, so this is when you should listen to your doctor.
Crystal arthritis refers to arthritis in which chemical crystals can be detected in the joint fluid, such as “gout” or “pseudogout”.
Fourth, chronic monoarthritis requires a biopsy of the synovial membrane, i.e., a pathological examination.
Chronic arthritis is defined as arthritis that is more than 8 weeks old and cannot be diagnosed. In contrast, those within 8 weeks are acute arthritis. Note that these two articles refer to “single” arthritis, but polyarthritis is a separate issue.
Fifth, gout rarely occurs in premenopausal women and rarely occurs in joints close to the spine.
Joints close to the spine include the hip and shoulder joints.
Number six, most shoulder pain is a disease of the tissues near the joint, such as bursitis and tendonitis. Most lower back pain does not require surgical intervention.
As mentioned above, most frozen shoulder is not a bone change in the shoulder joint. Regarding lower back pain, i.e. low back pain, low back pain, some surveys show that about two-thirds of adults have had low back pain, which is probably the second most common condition after the flu, and most of them not only do not require surgical treatment, but actually do not require long-term medical treatment, and lifestyle changes and exercise are very important. There are evaluations that show that low back pain is one of the diseases that are significantly “overmedicated”.
If osteoarthritis involves joints that are not commonly involved in “primary osteoarthritis”, such as the metacarpophalangeal, wrist, elbow, shoulder, and ankle joints, it is important to rule out joint damage caused by metabolic disease.
This article is a bit specialized, so let’s leave it to the doctor. Osteoarthritis is often referred to as “osteophytes” or “bone spurs”, but with more emphasis on the word “inflammation”, which can be simply understood as the period of attack of joint disease caused by bone spurs.
Article 8: The first attack of primary fibromyalgia syndrome rarely occurs before the age of 55 years, and patients with primary fibromyalgia syndrome rarely have abnormal laboratory parameters.
It is controversial whether “primary fibromyalgia syndrome” is a rheumatologic disease or not. Basically, patients complain of generalized muscle pain and all immunologic tests are normal, and pain medications are usually less effective than antidepressants.
Article 9, rheumatoid factor (RF) positive is not all rheumatoid, anti-nuclear antibody (ANA) positive is not all systemic lupus erythematosus.
This article is so meaningful that I hope patients will read it aloud a few times. Almost every clinic will encounter patients who are scared to death with their labs.
Article 10, if a patient with rheumatic disease has fever or multi-system damage, the first thing to rule out is “infection factor”, and only after the exclusion of infection is the cause of the original disease considered. Because the death caused by infection is obviously more than the death caused by rheumatism.
This is indeed a practical and empirical statement.
In dealing with diseases, knowledge is our greatest capital.