Leadership role of the rheumatologist: toward reaching a consensus

The rheumatologist is in the position to take a leading role in organizing interdisciplinary activities to unravel the confusion about treatment of rheumatologic disorders. Patients realize that all drugs carry some risk of side effects, but they are confused by input from conflicting sources - family members, neighbors, media, and nonmedical 'alternative' practitioners - as well as differing views from general practitioners, orthopedic surgeons, and rheumatologists. Only the rheumatologist is in a position to deal with the confusion, information, and misinformation. The rheumatologist understands that 'risk' is an expression of drug toxicity, patient expectation, and potential for improvement. Specifically, it is the rheumatologist who can best appreciate the benefits that many patients experience with nonsteroidal antiinflammatory drug (NSAID) therapy. In deciding whether to use an NSAID, the rheumatologist must decide for whom such agents are effective, when treatment should begin, which agent to use, and for how long therapy should continue. Relevant risk and benefit analysis is necessary for such decisions. The rheumatologist has to take the initiative in organizing interdisciplinary discussions and take active steps to educate society in general, the media, government, and colleagues. Only then will the approach to a vast problem be a sensible one.