Washington Post: Case of Delayed Rheum Diagnosis Save

The Washington Post recently published a "medical mystery" case titled, "Medical Mysteries: A rolled ankle set this runner down a painful path", which tells the tale of how and why rheumatologists are often not consulted or are consulted too late.

The patient is a 33 year old scientist and runner who rolled her ankle when her right foot got caught in a sidewalk crack she she fell out of her wedge heels. She rested for 2 weeks and then the pain and sausage like swelling recurred. 

In 2015, after another 6 week rest, an attempted 3 mile run was cut short with severe left ankle swelling.  For the next 8 yrs she treated her ankle pain with physical therapy before consulting doctors. Along the way she saw several PTs, a family MD, orthopedists and neurologic and orthopedic problems were considered. 

In 2023, surgery was planned but she was sent to a rheumatologist (as a prerequisite for surgery). The DC rheumatologist diagnosed her with enthesitis, psoriatic arthritis and found her to be HLA-B27 positive.  With treatment she improved. 

The patient attributed her delay to her "nonchalance" and thinking she could tough it out. But what she really needed was an accurate diagnosis.  Now she is wondering if she can restart her running again....