Pain and weakness are common complaints in patients presenting to rheumatologists
and other musculoskeletal pain experts. Often these patients complain of ill-defined
pain that has no specific delineating features. A common reason for specialty referral
usually is an abnormal immunologic test on an 'arthritis profile' or an unexpected
finding after an imaging procedure. Witness the individual who on complaining of generalized
pain, weakness, fatigue, malaise, and failure to thrive undergoes a battery of tests
to detect antibodies specific for various autoimmune diseases. Bone scan, MR imaging,
CT scan, nerve conduction study, electromyography (EMG), and a trial of high-dose
steroids yield conflicting results. The patient and referring physician may be concerned
that after such extensive investigation no diagnosis has been forthcoming. It often
is obvious to the rheumatologist or other specialist that many of these tests and
procedures were unwarranted and could have been obviated by a more frugal approach
to the use and interpretation of diagnostic tests.
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Article info
Footnotes
Address reprint requests to Glenn A. McCain, MD, FACP, Midatlantic Center for Pain Medicine, Southeast Arthritis Care Center, 1901 Randolph Road, Suite 221, Charlotte, NC 28207
Identification
Copyright
© 1996 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
