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Biomedical subjects

W A Katz

Publications and source records attributed to W A Katz.

At least 19 recordsLinked to original sources
PubMed2002

Musculoskeletal pain and its socioeconomic implications.

Pain is the most common reason for patients seeking advice from their physician. One adult in five suffers from chronic pain. In general, musculoskeletal pain, often in the form of arthritis, non-articular rheumatism, peripheral neuropathies and low back disorders, represents the most common cause of chronic non-malignant pain (CNMP). Exposure to low social support, low social anchorage or low social participation significantly increases the odds of a high level of pain. Most patients do not attribute chronic musculoskeletal pain to injury, but those who do report significantly higher levels of emotional distress. Pain is the third leading reason for absence from work in the United States, where the problem of chronic pain translates into an annual expenditure of at least $50 billion. The effectiveness of opioids for chronic pain goes unchallenged, but issues of potential dependence, abuse, and social and legal concerns have rendered their use in CNMP controversial. Numerous consensus statements, guidelines and policies have been issued by a variety of advocate organisations for the treatment of CNMP with opioids. Undertreatment of chronic pain persists despite the availability of drugs and other therapies for effective pain management.

Adult↗
PubMed1998

Yoga-based intervention for carpal tunnel syndrome: a randomized trial.

CONTEXT: Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity. OBJECTIVE: To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome. DESIGN: Randomized, single-blind, controlled trial. SETTING: A geriatric center and an industrial site in 1994-1995. PATIENTS: Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years). INTERVENTION: Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment. MAIN OUTCOME MEASURES: Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time. RESULTS: Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time. CONCLUSION: In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.

Adult↗
PubMed1998

The needs of a patient in pain.

Pain affects everyone at some point in their life. However, everyone experiences pain in a highly individualized way, and therefore, the management of pain must also be customized. Of the 3 general types of pain-acute, chronic malignant, and chronic nonmalignant-the latter is the least predictable and, therefore, can be the most difficult to treat. General principles of pain management can be summarized as (1) respecting the pain and the patient; (2) recognizing and addressing the psychosocial aspects of pain; and (3) treating the pain-and the underlying cause-appropriately and in a timely fashion. The best success in pain management relies on a multidisciplinary approach that includes patient education, medications, physical medicine, and psychological counseling. Although a number of effective analgesic drugs are available, all are associated with adverse events. To reduce the risk of these side effects, the patient's specific needs and medical history must be considered before initiating therapy. Central to effective management of chronic pain is a positive physician-patient relationship. Several strategies are discussed to help in building such a connection.

Analgesics↗
PubMed1996

Approach to the management of nonmalignant pain.

Pain is a universal, subjective, unpleasant sensation. It results from a noxious stimulus that causes the body to perceive existing or potential damage to its organs. The biochemical mechanism of pain is based on peripheral nociceptors that preferentially receive noxious stimuli and thereafter cause the primary afferent nociceptor fibers to release endogenous chemicals such as bradykinin, histamine, prostaglandins, serotonin, norepinephrine, and substance P. Additionally, substance P may stimulate prostaglandin and collagenase production, thus providing an explanation for the effectiveness of anti-inflammatory drugs in relieving pain. The interpretation of pain is highly individualized and embodies the entire personality. Thus, no two patients with pain can be treated in the same way. Pain is assessed through medical history, physical examination, and a variety of pain scales. General principles in managing pain call for the physician to (1) respect pain; (2) recognize the psychologic components of pain; and (3) treat the underlying disorder in a timely fashion. Modern management of pain evokes a multidisciplinary approach that includes patient education, pharmacologic intervention, physical medicine, minimally invasive procedures, psychologic counseling, behavioral modification and, in some instances, surgery or a variety of other nonpharmacologic modalities.

Analgesics↗
PubMed1996

Pharmacology and clinical experience with tramadol in osteoarthritis.

Tramadol is a centrally acting analgesic that has been shown to be effective in a variety of acute and chronic pain states. Unlike other centrally acting analgesics, it exerts a dual action by binding to the opioid receptor site in the central nervous system and by weakly inhibiting the reuptake of biogenic amines. Tramadol is rapidly and almost completely absorbed, with an onset of action occurring within 1 hour of oral administration. The recommended dosage is 50 to 100 mg every 4 to 6 hours; however, regular administration is an alternative, particularly for chronic pain states such as osteoarthritis, where the use of the recently developed sustained release formulation may represent an important advantage. Published studies specifically evaluating the use of tramadol in this disease support its effectiveness. Nausea, drowsiness, constipation, dizziness, and sweating have been reported in association with tramadol use. Nausea occurs early in the course of administration, and may be reduced by slowly titrating the dose of tramadol against response. Tramadol would appear to be particularly useful in the elderly population affected by osteoarthritis because, unlike nonsteroidal anti-inflammatory drugs, it does not aggravate hypertension or congestive heart failure, nor does it have the potential to cause peptic ulcer disease. Compared with narcotics, tramadol does not induce significant respiratory depression, constipation, or have significant abuse potential.

Analgesics, Opioid↗
PubMed1990

Challenging the pyramid. A new look at terapeutic approaches for rheumatoid arthritis. Patient selection.

The goals of therapy for rheumatoid arthritis (RA) address alleviation of pain; prevention of joint destruction, deformity, and disability; and maintenance of life style. Disease modifying antirheumatic drugs (DMARD) are among the most important agents to accomplish these goals, but guidelines for their introduction into management have not been clearly established. In 1986 a survey regarding DMARD usage was conducted among 1057 specialists in arthritis. The key criteria used in patient selection were progressive pattern of disease, persistent synovitis, and the degree of swollen joints. Eighty-four percent of respondents waited 3 to 6 months from the time of initial diagnosis of RA before starting DMARD. Parenteral gold was then the most preferred DMARD.

Anti-Inflammatory Agents↗
PubMed1988

Cyclobenzaprine in the treatment of acute muscle spasm: review of a decade of clinical experience.

Cyclobenzaprine hydrochloride became available for the treatment of acute skeletal muscle spasm ten years ago. The initial clinical trials conducted during the premarketing evaluation of this drug showed that it was significantly superior to placebo in relieving the signs and symptoms of acute skeletal muscle spasm. In addition, cyclobenzaprine was found to have a more rapid onset of action than diazepam. Data obtained both in controlled clinical investigations and in a postmarketing surveillance program indicated that cyclobenzaprine treatment was associated with few serious adverse experiences. Cyclobenzaprine represents a cost-effective approach to the management of acute muscle spasm, primarily because of the rapid symptomatic relief that it provides.

Amitriptyline↗
PubMed1985

Modern management of rheumatoid arthritis.

The management of rheumatoid arthritis can be challenging even to the most experienced and astute physician. The rheumatoid inflammatory process can be profound, ravaging, and unremitting, and the illness is notorious for its protean manifestations and capricious course. Moreover, the response to therapy is unpredictable, although it can be quite successful in many cases. Nevertheless, the intense pain, profound disability, progressive destructive arthropathy, and negative psychological milieu that haunt patients demand that something be done therapeutically. Rheumatoid arthritis responds best to a symphony of therapeutic modalities including drugs, rehabilitation, joint surgery, and attention to psychosocial issues. The foundation of any successful therapeutic venture is an educational program designed, however simply, to imbue the patient and family with an understanding of the disease and its course and treatment, and with realistic expectations. Drug therapy is often polypharmaceutical, employing analgesics, nonsteroidal anti-inflammatory agents, both local and systemic corticosteroids, and remission-inducing drugs. Pacing of lifestyle, physical and/or occupational therapy, vocational guidance, psychological and sexual counseling, and social intervention are as much a part of modern management in rheumatoid arthritis as are drugs. The extra-articular (systemic) manifestations are addressed in a variety of ways depending upon the type and severity of involvement. Although most patients can be treated by their primary care physician, some may require the expertise provided by a specialist. Finally, despite the lack of a cure for rheumatoid arthritis, most patients respond well to treatment and return to their desired activities of daily living.

Adrenal Cortex Hormones↗
PubMed1984

Proteinuria in gold-treated rheumatoid arthritis.

Treatment records of 1800 patients with rheumatoid arthritis who were included in the clinical trials of auranofin in the United States were examined for data on development of proteinuria. Three percent (41) of 1283 auranofin-treated patients had an abnormal 24-hour urine protein level: 15 had mild (0.15 to 1 g/d), 17 had moderate (1 to 3.5 g/d), and 9 had heavy (greater than 3.5 g/d) proteinuria. Permanent renal impairment did not occur, and proteinuria did not persist beyond 12 months in most patients. Seven of eight patients who were rechallenged when the proteinuria had cleared were able to continue treatment without relapse. No clinically discernible risk factors were found. Biopsy specimens from 4 patients showed membranous glomerulonephritis, which indicates an underlying immunopathologic mechanism. In similar groups of patients, the risk of developing proteinuria with auranofin therapy is significantly less than that with parenteral gold therapy (p less than 0.05) and similar to that with background therapy with nonsteroidal antiinflammatory drugs (p = 0.92). The lower incidence and relatively benign nature of proteinuria seen in this review support previous findings that auranofin is better tolerated than injectable gold.

Adult↗
PubMed1980

Hepatotoxicity associated with use of D-penicillamine in rheumatoid arthritis.

Two patients with rheumatoid arthritis developed evidence of hepatotoxicity while receiving D-penicillamine. Both recovered after withdrawal of the drug. These cases and a review of the literature suggested that hepatotoxicity, though rare, should be added to the list of adverse reactions to D-penicillamine.

Adult↗
PubMed1980

Moraxella infectious arthritis: first report in an adult.

The first occurrence of septic arthritis due to moraxella in an adult is reported. The clinical presentation mimicked disseminated gonococcaemia with associated gonococcal arthritis except for an atypical rash. Diagnosis was made by culture.

Adult↗
PubMed1980

Salivary gland dysfunction in systemic lupus erythematosus and rheumatoid arthritis. Diagnostic importance.

Salivary scintigraphy employing radionuclides has proved to be an accurate, reproducible method for demonstrating salivary gland involvement in Sjögren's syndrome. A prospective study was undertaken of 24 consecutive patients bearing a diagnosis of systemic lupus erythematosus (SLE), 78 consecutive patients bearing a diagnosis of classic or definite rheumatoid arthritis, and 18 control patients. Clinical of Sjögren's syndrome did not necessarily correlate with abnormal scintiscans. Extensive involvement, with greatly abnormal scintiscans (class 3 and 4), was found most consistently in patients who had SLE and who were seronegative for rheumatoid factor Salivary gland scintigraphy may ultimately serve as an adjunctive procedure for the diagnosis of this disease.

Adolescent↗
PubMed1970

The interaction of monosodium urate with connective tissue components.

Monosodium urate deposits almost exclusively in the connective tissues of patients with gout. Acetone dried homogenates of bovine nasal cartilage, but not of other tissues, markedly enhances the solubility of urate in buffers having molarities and hydrogen ion concentrations similar to that of most body fluids. The components of cartilage responsible for this effect are the proteinpolysaccharides, compounds of protein and chondroitin sulfate, called PPL. A progressive increase in PPL concentration results in a corresponding increase in urate solubility. If, on the other hand, unbound chondroitin sulfate or PPL digested by trypsin is used, then no significant augmentation of urate solubility occurs indicating that the integrity of the molecule is essential. One subfraction of PPL, PPL(5), causes an even more exaggerated response while another, PPL(3), causes a lesser one. These proteinpolysaccharide macro-molecules also inhibit the crystallization of urate from a supersaturated medium. The mechanism of the solubilizing phenomenon is not known. It is suggested that some type of physical or chemical binding is responsible. When, as a result of normal or accelerated connective tissue turnover, PPL is enzymatically destroyed, urate crystals then precipitate from the saturated tissue fluids.

Animals↗