Alvin Wells, MD, PhD: As rheumatologists, it’s key for us to think about rheumatic diseases and remember that these diseases are progressive in nature. They are chronic diseases. Even though we think about the joints, we think about the skin. Remember, these are systemic diseases as well. A systemic disease has a dramatic impact on a patient’s life. Take, for example, the things you and I might take for granted—like putting on your socks, buttoning your shirts, reaching into the cabinet to grab a bag of sugar. All those things have a dramatic impact on patients who have a rheumatic disorder. Therefore, the progressive nature of a chronic disease demands aggressive treatment. As a rheumatologist, my goal is to improve a patient’s quality of life.
One of the things we talk about, as rheumatologists, is establishing goals for our patients. I tell my patients—I make it very clear—that they are my customers. They’re paying me money for my best advice. When they come in to see me, I sit down with them and I say, “Hey, Mrs Smith, what are your goals? What do you want to accomplish?”
For an older lady, 70 years old, it could be that she wants to be able to see her grandkids during the summer. That’s her goal. I have a younger woman with a couple of kids. She wants to be able to continue to take her kids to soccer practice. That’s her goal. Other patients say their goal is, “Hey, I want to get rid of the pain, the stiffness, and swelling.”
As I sit with a patient, I identify the disease activity. But most important, I identify goals and what impact not being able to achieve or re-achieve those goals will have on the patient’s life.
Although not specific to rheumatic diseases, it is important to remember that patients have a significant number of comorbid conditions that might impact the drugs that we choose. For example, in patients who might have significant disease, if they’re older—40, 50, or 60 years old—we worry about hypertension. We worry about diabetes. We worry about high cholesterol. All those things are factors. Remember, when you have those other systemic diseases, we talk about other adverse effects and things that we might see in these patients, even before giving treatment. Are they at increased risk for infections? Are they at increased risk for having blood clots? Are they at increased risk for having hospitalization? Comorbid conditions impact my treatment decisions when managing patients with chronic rheumatic disorders.
Transcript Edited for Clarity