Biomedical subjects
Publications and source records attributed to C K Wasner.
Dealing with unproven treatments involves more than analyzing the available scientific data. The patient-physician relationship--the foundation of medical practice--is challenged and threatened by unproven treatments. To understand the problem, we need to understand ourselves as well as the patient and the disease. Handling the problem effectively can strengthen the patient-physician bond.
The traditional medical model (ie, history taking, physical examination, diagnosis, and treatment) is not sufficient in the management of chronic diseases such as arthritis. The complex social interactions that lead patients toward and away from traditional medical treatment must be recognized and addressed. Physicians need to acknowledge the likelihood that their patients may use unproven arthritis remedies and to make an effort to reduce the problem. Clinical research on the use of unproven remedies is needed, especially as it relates to complex physician-patient interactions. A good patient-physician relationship remains the basis of good clinical medicine and increases the likelihood of patient compliance.
The information available in the literature is controversial as to the association between HLA-DR and systemic sclerosis (SS). We studied 44 Caucasians with SS and found DR1 (P = 0.025; RR = 2.4) and DR5 (P = 0.05; RR = 3.8) to be increased whereas DR3 was not found to be increased when compared to local controls. The possible influence of a DR specificity in the clinical manifestations of SS was also investigated but not found.
Scleroderma is no longer the diagnostic or therapeutic dilemma it previously was. New diagnostic techniques facilitate earlier diagnosis, and many symptoms are amenable to treatment.
Rheumatologists and nephrologists were surveyed, by the use of specifically designed case histories, regarding their management of selected aspects of systemic lupus erythematosus (SLE). Treatment was individualized on a case by case basis by the vast majority of respondents. There was agreement on the initial treatment of SLE involving mild arthritis, active nephritis, or central nervous system disease and on steroid tapering practices. There was disagreement about treatment of a "serologic flare" and the management of late-stage nephropathy. Academic centers were more selective and less aggressive than practicing subspecialists. Areas of concordance document current standard treatment practices but sometimes show dissociation between the degree of consensus and the level of available medical knowledge.
A 33 year old female with systemic lupus erythematosus developed an aseptic meningitis with a polymorphonuclear CSF pleocytosis temporally correlated with ibuprofen. Several weeks later after one ibuprofen tablet this syndrome recurred. This represents the second report of this unusual manifestation and suggest an adverse reaction to ibuprofen in SLE patients.
Chronic arthritis management is complicated by patient administered unproven treatments. Disease, patient, and physician characteristics all contribute to this problem. Physicians must understand the complex cultural, sociological and psychological variables which encourage the use of unproven treatments. Part of any therapeutic regimen for chronic arthritis should include physician awareness and patient education regarding unproven treatments.