Systemic problems common with rheumatoid arthritis

A look at rheumatoid arthritis finds that its risks aren't always recognized for the constellation of effects it can lead to.

In patients with rheumatoid arthritis (RA), the immediate focus of treatment is on the joints. But because RA is a disease of inflammation, it can lead to systemic problems. Indeed, recent research has found that RA patients have as high a risk for cardiovascular disease as do diabetics, or perhaps even higher, although it isn't always recognized. RA patients are also at increased risk for certain types of cancer, including lymphomas and lung cancer, and drugs used to treat RA can increase risk for opportunistic infections. Internists caring for RA patients should be aware of the disease's constellation of effects so they can provide targeted screening and treatment. In our story, leading experts detail what to look for and how to optimize care.

In March 2009, Washington became the second U.S. state after Oregon to permit physician-assisted suicide. With the recent anniversary of its Death with Dignity Act, and a December 2009 court ruling in Montana effectively permitting physician-assisted suicide in that state, what do internists need to know about this controversial issue? Where the practice is legal, physicians will need to decide how to respond if patients request a lethal prescription. But the issue—and the resulting controversy—affects all physicians, some experts say, because of the larger questions it raises about optimal end-of-life care. Some argue that making physician-assisted suicide an option helps elevate care quality by facilitating honest discussion, while others, including ACP, consider it harmful to the doctor-patient relationship, among other objections. Our story looks at Washington's experience with physician-assisted suicide and puts it into context for physicians practicing in every state.

We feature the latest installment of Mindful Medicine, which uses reader-submitted cases to illuminate the art of diagnosis. This month's case deals with an elderly obese woman with colon cancer hospitalized for nausea and anorexia whose mental status began to deteriorate. Our columnists, Jerome Groopman, FACP, and Pamela Hartzband, FACP, discuss how this case emphasizes the importance of taking a careful, thorough history and avoiding attribution error.

As always, we enjoy hearing from you. Please send your comments and questions, and your ideas for future Mindful Medicine columns.


Jennifer Kearney-Strouse