A dietician should be involved early in the course of treatment to ensure adequate nutritional support is provided. Dr. Boin explained that a prolonged course of parenteral nutrition is often indicated.
Surgical intervention should be reserved for refractory cases, instances of true mechanical blockage, perforation or intestinal necrosis.
In Sum
Dr. Boin was comprehensive and thorough in discussing these potential clinical scenarios that rheumatologists may encounter, particularly as consultants in the hospital and when working in interdisciplinary teams. A key theme was the importance of early recognition of the emergencies seen in patients with scleroderma. Rheumatologists need to be aware of the risk factors associated with these emergent conditions and the clinical findings that should lead to a high level of suspicion for such entities.
As Nobel Prize winner in economic sciences Daniel Kahneman once said, “Intelligence is not only the ability to reason; it is also the ability to find relevant material in memory and to deploy attention when needed.”3 Truer words could not be spoken.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Logee KM, Lakshminarayanan S. Scleroderma renal crisis as an initial presentation of systemic sclerosis: A case report and review of the literature. Clin Exp Rheumatol. 2015;33(4 Suppl 91):S171–S174.
- Ebert EC. Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol. 2008 Jan;42(1):5–12.
- Kahneman D. (2011). Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.
