The physician’s tactics at the first visit of a patient with suspected rheumatic disease
https://doi.org/10.14412/1996-7012-2025-6-85-91
Abstract
At the first consultation of a patient with suspected rheumatic disease (RD), the physician must form a diagnostic concept, determine the scope of diagnostic evaluation, decide on the need for further routing of the patient, consider the treatment strategy, and make initial prescriptions aimed at controlling the main and most burdensome symptoms (most likely musculoskeletal pain). One of the central elements of the consultation should be a thorough analysis of complaints and medical history, as well as a complete physical examination, allowing the identification of many key symptoms necessary for the differential diagnosis of RD. Considering the time constraints, the physician’s actions should be consistent and deliberate. Creating a favorable psychological environment is of great importance, achieved by demonstrating confidence, empathy, and avoiding “forbidden phrases” that may upset the patient and even provoke conflict.
In most cases, the consultation should end with recommendations that reduce the patient’s suffering and improve quality of life. This primarily concerns the prescription of analgesics. At the first visit, it is advisable to recommend well-known medications with proven therapeutic potential and a favorable safety profile. Among nonsteroidal anti-inflammatory drugs, such an agent is aceclofenac; among centrally acting muscle relaxants — tolperisone hydrochloride.
Keywords
first patient visit,
rheumatic disease,
musculoskeletal pain,
aceclofenac,
tolperisone hydrochloride
Supporting agencies: The article is sponsored by Gedeon Richter Pharma
About the Authors
A. E. Karateev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Andrey Evgenyevich Karateev
34A, Kashirskoe Shosse, Moscow 115522
E. Yu. Polishchuk
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
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For citations:
Karateev AE, Polishchuk EY. The physician’s tactics at the first visit of a patient with suspected rheumatic disease. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2025;19(6):85-91. (In Russ.) https://doi.org/10.14412/1996-7012-2025-6-85-91
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