Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Rheumatology
Published in: Clinical Rheumatology 6/2017

01-06-2017 | Editorial

Diagnostic uncertainty and epistemologic humility

Authors: Andrew Kelly, Richard S. Panush

Published in: Clinical Rheumatology | Issue 6/2017

Login to get access

Excerpt

“The essence of medicine is the reduction of uncertainty.” (Baldhius, as quoted by J Claude Bennett, MD {cited in [1]}) …
Literature
1.
Perret D, Chang EY, Pang W, Shinada S, Panush RS (2013) Reflecting on pain management for patients with osteoarthritis and other rheumatic disorders: there’s more to pain management than managing pain. Pain Management 2(4):295–301CrossRef
2.
Bengson J, Moffett MA (2012) Knowing how: essays on knowledge, mind, and action. Oxford University Press
3.
4.
Dubois EL, Wallace DJ (1987) Dubois’ Lupus Erythematosus. Lea and Febiger, Philadelphia
5.
6.
7.
Klemperer P (1961) The concept of collagen diseases in medicine. Amer Rev Respir Dis 83:331–339
8.
9.
Doria A, Mosca M, Gambari PF, Bombardieri S (2005) Defining unclassifiable connective tissue diseases: incomplete, undifferentiated, or both? J Rheumatol 32:213–215PubMed
10.
LeRoy EC, Maricq HR, Kahaleh MB (1980) Undifferentiated connective tissue syndromes. Arthritis Rheum 23:341–343CrossRefPubMed
11.
Kallenberg CG (1993) Overlapping syndromes, undifferentiated connective tissue disease, and other fibrosing conditions. Curr Opin Rheumatol 5:809–815CrossRefPubMed
12.
Alarcon GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Wilkens RF et al (1991) Early undifferentiated connective tissue disease. I. Early clinical manifestations in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease. J Rheumatol 18:1332–1339PubMed
13.
Clegg DO, Williams HJ, Singer JZ, Steen VD, Schlegel S, Ziminski C, Alarcon GS, Luggen ME, Polisson RP, Wilkens RF et al (1991) Early undifferentiated connective tissue disease. II. The frequency of circulating antinuclear antibodies in patients with early rheumatic diseases. J Rheumatol 18:1340–1343PubMed
14.
Bulpitt KJ, Clements PJ, Lachenbruch PA, Paulus HE, Peter JB, Agopian MS, Singer JZ, Steen VD, Clegg DO, Ziminski CM, Alarcon GS, Luggen ME, Polisson RP, Wilkens RF, Reading JC, Williams HJ, Ward JR (1993) Early undifferentiated connective tissue disease: III. Outcome and prognostic indicators in early scleroderma (systemic sclerosis). Ann Intern Med 118:602–609CrossRefPubMed
15.
Alarcon GS, Willkens RF, Ward JR, Clegg DO, Morgan JG, Ma KN, Singer JZ, Steen VD, Paulus HE, Lugger ME, Polisson RP, Ziminski CM, Yarboro C, Williams HJ (1996) Early undifferentiated connective tissue disease. IV. Musculoskeletal manifestations in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of patients with well-established connective tissue diseases: follow-up analyses in patients with unexplained polyarthritis and patients with rheumatoid arthritis at baseline. Arthritis Rheum 39:403–414CrossRefPubMed
16.
Panush RS, Greer JM, Morshedian KK (1993) What is lupus? What is not lupus? Rheum Dis Clin N Am 19:223–234
17.
18.
Panush RS, Edwards NL, Longley S, Webster E (1988) “Rhupus” syndrome. Arch Intern Med 148:1633–1636CrossRefPubMed
19.
Wolfe F, Ross K, Hawley DJ, Robertss FK, Cathey MA (1993) The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol 20:2005–2009PubMed
20.
Panush RS, Hadler NM, Hellman DB, Leroy EC (1999) Yearbook of rheumatology, arthritis and musculoskeletal disease. In: Panush RS (ed) Health sciences, epidemiology, and economics (sex, sensationalism, greed, politics, law, and junk science: the story of the silicone breast implant controversy). Mosby-Yearbook, Missouri, pp 1–5
21.
Angell M (1997) Science on trial: the class of medical evidence and the law in the breast implant case. WW Norton, New York
22.
Kroenke K, Mangelsdorr AD (1989) Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 86:262–266CrossRefPubMed
23.
Kanton W, Ries RK, Kleinman A (1984) The prevalence of somatization in primary care. Compr Psychiatry 25:208–215CrossRef
24.
Kanton WJ, Walker EA (1998) Medically unexplained symptoms in primary care. J Clin Psychiatry 59(Suppl 20):15–21
25.
Kroenke K, Price RK (1993) Symptoms in the community: prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153:2474–2480CrossRefPubMed
26.
Creed F, Barsky A (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 56:391–408CrossRefPubMed
27.
28.
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision. American Psychiatric Association, Washington DCCrossRef
29.
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). American Psychiatric Association, ArlingtonCrossRef
30.
Yutzy SH, Parish BS (2008) Somatoform disorders. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th ed. American Psychiatric Publishing, Washington, DC
31.
Goldenberg DL (1987) Fibromyalgia syndrome an emerging but controversial condition. JAMA 257:2782–2787CrossRefPubMed
32.
33.
Bennett RM (2009) Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin N Am 35:215–232CrossRef
34.
Institute of Medicine (2015) Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. The National Academies Press; 2015 http://​www.​iom.​edu/​mecfs. Accessed on 28 March 2017
35.
Mehta NR, Forgione AG, Rosenbaum RS, Holmberg R (1984) “TMJ” triad of dysfunctions: a biologic basis of diagnosis and treatment. J Mass Dent Soc 33:173–176PubMed
36.
Cooper BC, Kleinberg I (2007) Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio 25:114–126CrossRefPubMed
37.
Hartlage SA, Freels S, Gorman N, Yonkers K (2012) Criteria for premenstrual dysphoric disorder: secondary analyses of relevant data sets. Arch Gen Psychiatry 69:300–305CrossRefPubMedPubMedCentral
38.
Halbreich U, Backstrom T, Eriksson E et al (2007) Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol 23:123–130CrossRefPubMed
39.
Eis D, Helm D, Mühlinghaus T, Birkner N, Dietel A, Eikmann T, Gieler U, Herr C, Lacour M, Nowak D, Pedrosa Gil F, Podoll K, Renner B, Andreas Wiesmuller G, Worm M (2003) The German multicentre study on multiple chemical sensitivity (MCS). Int J Hyg Environ Health 211:658–681CrossRef
40.
Hausteiner C, Bornschein S, Bickel H et al (2003) Psychiatric morbidity and low self-attentiveness in patients with environmental illness. J Nerv Ment Dis 191:50–55CrossRefPubMed
41.
Das-Munshi J, Rubin GJ, Wessely S (2007) Multiple chemical sensitivities: review. Curr Opin Otolaryngol Head Neck Surg 15:274–280CrossRefPubMed
42.
Cahalan S (2012) Brain on fire: my month of madness. Penguin, NYC
43.
Rate RG, Morse HG, Bonnell MD et al (1980) “Navajo arthritis” reconsidered: relationship to HLA-B27. Arthritis Rheum 23(11):1299–1302CrossRefPubMed
44.
Martin RW, Duffy J, Engel AG, Lie JT, Bowles CA, Moyer TP, Gleich GJ (1990) The clinical spectrum of the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion: clinical features in 20 patients and aspects of pathophysiology. Ann Intern Med 113(2):124–134CrossRefPubMed
45.
Kohn NN, Hughes RE, McCarty DJ Jr, Faires JS (1962) The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the “pseudogout syndrome”. II. Identification of crystals. Ann Intern Med 56:738–745CrossRefPubMed
46.
Johnson JA, Yu SS, Elist M, Arkfeld D, Panush RS (2015) Rheumatologic manifestations of the “MonoMAC” syndrome. A systematic review. Clin Rheumatol 34(9):1643–1645CrossRefPubMed
47.
Hadler NM, Greenhalgh S (2004) Labeling woefulness: the social construction of fibromyalgia. Spine 30:1–4CrossRef
48.
Hadler NM (2003) “Fibromyalgia” and the medicalization of misery. J Rheumatol 30:1668–1669PubMed
49.
50.
Metadata
Title
Diagnostic uncertainty and epistemologic humility
Authors
Andrew Kelly
Richard S. Panush
Publication date
01-06-2017
Publisher
Springer London
Published in
Clinical Rheumatology / Issue 6/2017
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-017-3631-8

Other articles of this Issue 6/2017

Clinical Rheumatology 6/2017 Go to the issue

Brief Report

Autoantibodies to types I and IV collagen and heart valve disease in systemic lupus erythematosus/antiphospholipid syndrome

Original Article

The impact of peer victimization and psychological symptoms on quality of life in children and adolescents with systemic lupus erythematosus

Original Article

Efficacy of combination DMARD therapy vs. hydroxychloroquine monotherapy in chronic persistent chikungunya arthritis: a 24-week randomized controlled open label study

Original Article

Prevalence and characterization of non-sicca onset primary Sjögren syndrome with interstitial lung involvement

Erratum

Erratum to: The conversion rate of tuberculosis screening tests during biological therapies in patients with rheumatoid arthritis

Original Article

Contribution of subjective Disease Activity Score 28 (DAS28) components to the response to treatment of rheumatoid arthritis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits