Principles of management

Abstract

The care of a patient with systemic sclerosis (scleroderma) is particularly challenging because of the multiple potential complications of scleroderma, the variable clinical course, and imperfect treatment options. For many rheumatologists, as well as for our patients, this situation has resulted in a pessimistic attitude toward therapy that may not be warranted. It is clear that the management of scleroderma requires a multidisciplinary approach, and the responsibility to integrate results and coordinate care usually falls to the rheumatologist. From the patients' perspective, visits to multiple subspecialties can lead to confusing or even conflicting advice and inadequate explanations as to the cause of their symptoms. Our patients are justifiably concerned that each subspecialist is focused on a single organ and that no one is looking at the entire picture. There is a sense that communication among physicians is poor and that test results are not shared in a timely fashion or not shared at all. The task of integrating care and interpreting test results falls to rheumatologist who is the most logical person to perform this role. This provides the opportunity to provide not just medical treatment but also the assurance that someone understands their disease from "head to toe" and is in charge of their case.