Dr. Kaufman's Comments on the Treatment
Joint Dysfunction 3
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COMMON FORM OF JOINT DYSFUNCTION
(Dr. Kaufman’s practical recommendations for case management is summarized in this short chapter. References cited in this chapter are posted at http://www.doctoryourself.com/kaufman11.html )
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Coordination of Treatment of Joint Dysfunction and the Four Complicating Syndromes
In previous sections,
joint dysfunction and the four complicating syndromes were
Even though a patient's Joint Range Index has been therapeutically elevated to 96-100 (no joint dysfunction), he may still have one or more of the complicating syndromes, which require successful treatment if he is to feel well.
The treatment of joint dysfunction
and the four complicating syndromes is time-
The differential diagnosis of the four commonly occurring complicating syndromes may be relatively easy, or extremely difficult. In some patients, when the four syndromes exist as apparently independent clinical entities, the successful treatment of any one syndrome does not influence the remaining syndromes, and all four syndromes must be treated successfully if the patient is to feel well. In other patients, the four complicating syndromes may appear to be interrelated as primary and collateral conditions, and the successful treatment of the primary syndrome also affords relief from the collateral syndromes. Thus, it may be necessary for the physician to recognize which of the patient's complicating syndromes are primary and which are secondary, and to treat the primary syndrome(s) first. For example, a patient with the chronic allergic pain syndrome may have collateral anxiety about the meaning of his symptoms, which generates psychogenically induced, sustained hypertonia of somatic muscle; this in turn causes the delayed post-traumatic articular syndrome; additionally, the chronic food allergy may cause some degree of excessive sodium retention. The elimination of the offending food from the patient's diet will correct his allergic pain syndrome, and will also relieve his anxiety and collateral complicating syndromes (psychogenically induced, sustained hypertonia of somatic muscle, delayed post-traumatic articular syndrome, and sodium retention syndrome). Treatment in this instance of any or all of the collateral syndromes will give the patient little or no benefit if the chronic allergic pain syndrome remains uncorrected.
Even though the patient's initial complicating syndromes are corrected, he may have at any time a recurrence of these syndromes, or he may develop for the first time any other complicating syndromes or diseases. Such changes in the patient's clinical status require appropriate study and treatment.
The presence or absence of joint dysfunction can be ascertained from the determination of the Joint Range Index. The presence or absence of the four complicating syndromes may be apparent at once to the physician upon completion of the initial clinical study, or the diagnosis must be tentative, pending further study, including observation of the patient's response to a trial of therapy. The diagnostic conclusions derived from studying a patient by the methods outlined in previous sections may be conveniently summarized in the form suggested below, and must be revised from time to time to describe the patient's current clinical status.
With or without
clinically obvious arthritis: Regional or generalized;
With or without x-ray signs
of arthritis: Regional or generalized; Hypertrophic,
II. Delayed Post-Traumatic Articular Syndrome
III. Chronic Allergic Syndromes (Pain, Fatigue, or Mental)
IV. Sodium Retention Syndrome
V. Psychogenically Induced, Sustained Hypertonia of Somatic Muscle (With or without other psychogenic syndromes.)
Note: The terms "psychogenic rheumatism" and "psychosomatic rheumatism" (15) (16) (52) (67) (68) (78) (86) (89) (91) (98) (123) (248) are not employed in this classification since it is thought that these terms, as commonly used today, indicate a clinical complex consisting of certain identifiable elements: joint dysfunction, delayed post-traumatic articular syndrome, psychogenically induced, sustained hypertonia of somatic muscle, and, often, the chronic allergic syndromes and the sodium retention syndrome.
The four complicating
syndromes may be further classified according to degree of
A method for coordinating
the treatment of joint dysfunction and the four commonly
At the time of the
initial clinical study, the patient with joint dysfunction is given
Psychotherapy starts when
the patient and physician first meet, and continues during the course of
treatment for joint dysfunction, being supportive, preparatory, or
If a patient appears to
have the delayed post-traumatic articular syndrome, the
The patient is asked to
keep a food-symptom diary, which is examined at monthly
During the course of
treatment of a patient who has joint dysfunction and the four
Thus, the patient is, in
effect, testing in reality the validity of the physician's analysis of his
problems, by prematurely dropping adequate niacinamide therapy, by
Although the desired goal is the solution of the patient's clinical problems through proper analysis of his illness, and application of corrective therapy, palliative remedies are used when necessary to give the patient relief from his troublesome symptoms.
The patient is always
encouraged to live as active and as full a life as is possible,
(End of Chapter 3. References cited in this chapter are posted at http://www.doctoryourself.com/kaufman11.html )
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