The pitfalls in the diagnosis and treatment of rheumatic diseases

Rheumatism is defined as any abnormalities related to bone, joint, muscle or other connective tissues. It is presented as different clinical symptoms/signs and even atypical ones during the disease progressed. Besides, the highly overlapping characteristics exist between many rheumatic diseases and some doctors may fall into the unnecessary pitfalls in daily practice. These factors lead to over-, under- or mis-diagnosis occasionally. The two major pitfalls are that individual carrying an immunological marker is sometimes considered as a victim of rheumatic disease and some kind of rheumatic diseases affects only specific age group or gender exclusively. The examples of the former are rheumatoid factor is looked as the same meaning as rheumatoid arthritis; anti-nuclear antibody is equivalent to systemic lupus erythematosus; human leukocyte antigen HLA-1327 equals to ankylosing spondylitis; and hyperuricemia means gouty arthritis. The instances of the latter are systemic lupus erythematosus affect young females only; ankylosing spondylitis solely involve young male; gouty arthritis seldom happen in young people. In fact, these concepts are all misunderstanding. There are several out-of-date or wrong notions about the treatment of rheumatic diseases which may induce ineffective results. For example, treating rheumatoid arthritis according to the conventional pyramid model may lead to the missing of golden treatment period; prescribing large amount of corticosteroid in patients of systemic lupus erythematosus for afraid of potential side effects of immuno-suppressive agents and eventually lead to un-wanted side effects of steroid; abuse of non-steroidal anti-inflammatory drugs leads which severe complications such as upper gastro-intestinal bleeding; prescribing hypouricemic agents promptly for any patients of asymptomatic hyperuricemia. The purpose of this article is to discuss and clarify the pitfalls frequently encountered in the daily medical practice.