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Rheumatoid arthritis: young, sick, and in need of support

BMJ 2011; 342 doi: (Published 05 January 2011) Cite this as: BMJ 2011;342:c7450

Fourteen months ago I met my 21 year old daughter near her student digs. I was struck by how pale and haunted she looked. As we walked along the street together she berated me for going too quickly and complained that her knee hurt.

Weeks later she admitted that over the past few months she had been investigated by her local practice, but not referred, for fatigue and a flitting polyarthritis. As a doctor I was fortunate to be able to ask a friend who is rheumatologist for advice. He kindly offered to see her, diagnosed rheumatoid arthritis, gave her intramuscular steroids, and referred her to a local specialist.

The injection had a magical effect. My partner and I felt optimistic. Could the steroids have turned the disease off? Maybe it wasn’t rheumatoid arthritis, or if it was, it would not be severe. The therapeutic honeymoon was short lived, however, and the seven week wait for the consultant appointment seemed long.

First line treatment with methotrexate did not seem to help; nor did the addition of two further disease modifying drugs. Four months into her treatment …

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