Jack-I will re-try sending this. Your comment "Not all symptoms merit a diagnosis or disease, some are just evidence of human imperfection" - J Cush, MD- strikes a chord with me as I work 6 months a year in locums to keep my skills up. I see many people who have been labeled as inflammatory arthritis, SNRA, UCTD, etc dutifully treated with multiple DMARDs and biologics. Over time, their rheumatologists change but the EHR continues to represent a label as a diagnosis. Subsequent rheumatology providers choose to continue the treatments with dangerous and expensive meds without re-visiting the diagnosis. They take the easy way out and run the patient thru rather than re-invent the wheel or upset the patient who usually doesn't have a clue (especially if underprivileged). No critical thinking or intellectual honesty-just get 'em in and get 'em out and look good on paper (screen of EHR). Very worrisome and a real trap for those who are taking care of he EHR more than the patient. The treatment decisions seem permanent and are not re-evaluated over time for many patients in this uncertain diagnosis category. After FMS, SNRA is a vexing diagnostic label.-David