Zen like approach to the evaluation of chronic polyarthritis
Many chronic polyarticular diseases may require months or years to diagnose; therefore, tremendous patience is often required. This prolonged but necessary period of observation may be frustrating to many patients (and providers) who may expect an immediate diagnosis. Zen philosophy is based on the idea that life can be difficult and the primary source of personal discontent is an individual’s longing for things to be different. Contentment lies in the acceptance of the complexities of life and the ability to let go of this desire and longing. Clinicians and trainees that desire clearly defined diagnoses at presentation may be more content in fields where fractures and acute coronary syndrome are commonplace. In contrast, the characteristics of chronic polyarticular diseases require an extraordinary degree of patience and a long-term perspective, in that:
• Many present insidiously with few objective findings for prolonged times.
• Many initially masquerade as other diseases before finally settling into their usual pattern.
• Characteristic laboratory abnormalities may require months or years to develop.
• Joint symptoms may precede the extraarticular features of the disease by months or years.
• Joint radiographs may not show characteristic changes of arthritis for months or years.
As Sir William Osler famously said, “Medicine is a science of uncertainty and an art of probability.” He was likely thinking of rheumatology when he made this observation.