It’s Not A Contest

One of the hardest things to deal with, after leaving a rheumatologist’s office with a new diagnosis, is the ignorant comments from friends.  Our society lives with the delusion that given any aches and pains, a trip to the doctor will result in a diagnosis and a prescription to make everything right again.  Wouldn’t it be nice if that were how life really worked?

With a new diagnosis, wanting a listening ear and a little sympathy while we try to get our bearings and figure out what happened to our life, it’s distressing to be dismissed with a shrug and insensitivity:

  • Oh, I have that, too, in my little finger
  • Aren’t you too young for that?
  • Just take a Motrin

Recalling those days, I try to be supportive when I meet others facing similar challenges.  I was surprised then, a few weeks ago, by one man’s response.

After shaking hands, I thanked him for not squeezing too hard.  His wife (standing beside him) said, “Well, he has arthritis.”  Guessing that he’s about my age – maybe a bit younger – I asked, “Oh?  What kind?” and was informed that he has polyarticular arthritis.  Thinking to lend a little support, I mentioned that I understand, since I have RA.  He snapped, “Well, mine’s worse!  It’s in every joint.”

I was taken aback.  The online community is extremely supportive of one another, so it was shocking to think I was offering understanding/commiseration and have it thrown back in my face, and also have my circumstances belittled.

Inside I was seething.  How dare he!  What kind of idiot automatically assumes his condition is worse than someone else’s?  How could he remember a long word like “polyarticular” yet not know enough about it to realize what a jerk he was being?  If I were ten years old again, I’d have shouted back at him, “Oh, yeah?  Well that’s not even a real diagnosis!  What ICD-9 code is your rheumatologist using?”  Fortunately, I’m only ten in my head, so I kept my mouth closed and walked away.

Later I started second-guessing myself.  Maybe I’d forgotten what polyarticular arthritis is; maybe I was confusing it with something else.  I looked it up.  Polyarticular arthritis means inflammation of more than four joints.  It’s a symptom, like “sore throat” or “abdominal pain.”  The trick is to figure out the cause, and the differential diagnosis for “inflammation of more than four joints” is a long list of possibilities.  It includes things like parvovirus, Epstein-Barr virus, hepatitis B, HIV, gonorrhea, chlamydia, salmonella, lyme disease, multiple myeloma, plus a host of autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, scleroderma, Sjogren’s syndrome, and lupus.  It was just what I remembered:  the symptom is inflammation in many joints; the diagnosis says which disease is responsible.*  Obviously, treatment will vary depending on which disease is causing the inflammation.

I feel sorry for the man.  Imagine going through life competing to have the worst disease.  I didn’t know it was a contest.

If it were a contest, it’s one I’d be happy to lose.

*If the doctor can’t figure out which disease is causing the symptoms, unspecified polyarthropathy or polyarthritis is a possible diagnosis (ICD9 code 716.5 ).