Chronic Arthritis is often not a follow-the-textbook disease

By Dr Irwin Lim, Rheumatologist

I own a couple of textbooks of rheumatology, used them as references and only read a small part of these books. I'm not really a cover-to-cover type of student which seems strange to admit.

Rheumatology training was very much an apprenticeship.

You watched and mimicked. You were mentored by wiser, greyer heads.

I learned in the clinic and on the wards. Then I left the sheltered workshop.

In private practice, chronic arthritis is often not a follow-the-textbook disease:

• Sufferers simply experience disease in many different ways
• The range of symptoms, especially for autoimmune arthritis, can be huge
• Patients may cope with the "same" disease in many different ways
• Patients respond or react to the same medication in different ways

While some patients will swear that their arthritis flares with alcohol or tomatoes or gluten, there are many others who do not. While some patients note that the weather impacts their arthritis, there are many others who don't see any pattern.

Most textbooks, and at least all the ones I read, are written by doctors.

These doctors are very good ones, and very learned but I'm not sure how much input patients may have had.

The skill as a specialist rheumatologist is not in picking the textbook case. It's in picking the variant.

Or at least accepting that it's not always possible to get the diagnosis right, first up.

Keeping an open mind and being happy to review and to change course is a good trait.

Was your arthritis a textbook example?