GOLD-CON-05

SYNTHETIC RECORD - Example Cascade Rheumatology - Problem List Update - 2026-06-08
Patient reference SYN-5502. 34-year-old woman.

- Psoriatic arthritis, asymmetric, with nail pitting and dactylitis of the third toe; rheumatoid arthritis excluded given seronegative serology and the distribution of joint involvement.
- Methotrexate 20 mg weekly from 2026-01-05 to 2026-05-18, discontinued for inadequate response.
- Mild plaque psoriasis on the scalp, stable.
- Plan: discuss Immunara given the inadequate response to methotrexate; dermatology follow-up for skin disease.

SYNTHETIC RECORD - Example Cascade Rheumatology - Follow-up Visit - 2026-06-10
Patient reference SYN-5502. A second clinician at this practice saw this 34-year-old woman this week for ongoing joint symptoms.

Her chart carries an established diagnosis of rheumatoid arthritis, and her hand and wrist swelling has continued despite treatment. She completed oral methotrexate 20 mg weekly from 2026-01-05 to 2026-05-18, which was stopped because her synovitis had not improved, an inadequate response. She works as a dental hygienist and describes ongoing difficulty gripping instruments.

Immunara is recommended given her sustained disease activity.

SYNTHETIC RECORD - Example Cascade Rheumatology - Laboratory Report - 2026-05-28
Patient reference SYN-5502.
Rheumatoid factor: negative, 8 IU/mL (reference <14).
Anti-CCP antibody: negative, 4 U/mL (reference <20).
ESR: 30 mm/hr (elevated).
CRP: 1.6 mg/dL (elevated).