At the beginning of the twentieth century, the old remedies of purging and bloodletting were left behind. Lister’s concepts of cleanliness had finally become widely accepted. Human anatomy was documented. The culprits of bacteria were identified. Medical knowledge base was growing beyond imagination. Yet doctors were stuck. There was no cure for a bacterial infection. There was no cure for a strep infection. If you were stricken with a strep throat, there was a good chance that you would die. Doctors had no solutions and people of all ages died from pneumonia, wound infections, meningitis, and more. Infection was feared. Today all this is unimaginable. But then, Ehrlich’s ‘magic bullet’ was yet to be discovered.

The world changed forever with the discoveries of sulfa in 1936. Penicillin was refined and put into production in the 1940s. There were many more ‘magic bullets’ to follow. Doctors finally had new tools for their toolbox. It became the age of knowledge plus tools. Life became much better. Lifespans became longer.

Today, in the twenty-first century, our doctors have a new problem. Medical knowledge. Presently, there is an incredible library of established knowledge with more being added every day. In any one field, there is a huge amount of knowledge to learn, let alone remember. So, our doctors who originally started with the simple tools of purging and bloodletting  have arrived at a place of almost too much information.

How to manage information and treat patients with the best of it is today’s conundrum for the medical community, our doctors. Their answer is the use of algorithms. Below is the ACR 2015 Recommendations for Established Rheumatoid Arthritis. The first algorithm is the ACR 2015 Recommendations for New Patients with Rheumatoid Arthritis.

So you can rest assured that your rheumatologist does indeed have a plan.  It is an algorithm but it will work for many patients. Do you see yourself in the chart? I am not there because I have dropped off the bottom. And, there is no second page for those of us outliers who do not fit within the algorithm. Maybe the next ‘magic bullet’ will be for us.

Note: If you would like to read the full 2015 ACR report, google it. That is quick and easy.