Diagnostic uncertainty and epistemologic humility

Kelly, Andrew; Panush, Richard S.

doi:10.1007/s10067-017-3631-8

Cited by 20 publications

(9 citation statements)

References 43 publications

(34 reference statements)

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“…Autoimmune diseases are a rare but important cause of recurrent pericardial effusions, and patients with scleroderma often present with pericardial effusion as their initial symptom. 1 Many patients with a rheumatologic condition go undiagnosed for years, 2 as with the presented case. With recurrent effusion, one must investigate the cause to prevent worsening morbidity, as simple drainage will not prevent reaccumulation of the fluid.…”

Section: Introductionsupporting

confidence: 51%

Scleroderma as an uncommon cause of pericardial effusion: a case report

Yee

Varada

Rahimi

et al. 2022

kjm

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Section: Introductionsupporting

confidence: 51%

Scleroderma as an uncommon cause of pericardial effusion: a case report

Yee

Varada

Rahimi

et al. 2022

kjm

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“…Patients with SLE often present with autoimmune thyroiditis, SS, RA, autoimmune hepatitis or APS [ 2 ]. Overlap syndrome is defined as the co-occurrence of manifestations of several recognized and diagnostically confirmed autoimmune diseases in the same patient [ 3 ], although this area remains open to debate [ 4 ]. One example would be MCTD, which shares clinical characteristics with SLE, SSc, PM/DM and RA.…”

Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

et al. 2019

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Objectives This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies.

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“…"Recommendations and criteria sets for diagnosis or classification may provide guidance but often fall short of converting the specificities of each individual patient into a confident diagnosis" they write (p. 267). A similar position is taken by Kelly and Panush (2017) who, in their article on diagnostic uncertainty, coin a new diagnosis that they can use when there is not a diagnosis, or when a patient presents symptoms from a variety of different disorders. The propose "overlap syndrome."…”

Section: Sloppy and Idle: Diagnostic Uncertainty In The Twenty-first Centurymentioning

confidence: 92%

Uncertainty and the inconvenient facts of diagnosis

Jutel

2021

Endeavour

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One common contemporary usage of the term "diagnostic uncertainty" is to refer to cases for which a diagnosis is not, or cannot, be applied to the presenting case. This is a paradoxical usage, as the absence of diagnosis is often as close to a certainty as can be a human judgement. What makes this sociologically interesting is that it represents an "epistemic defence," or a means of accounting for a failure of medicine's explanatory system. This system is based on diagnosis, or the classification of individual complaints into recognizable diagnostic categories. Diagnosis is pivotal to medicine's epistemic setting, for it purports to explain illness via diagnosis, and yet is not always able to do so. This essay reviews this paradoxical use, and juxtaposes it to historical explanations for non-diagnosable illnesses. It demonstrates how representing non-diagnosis as uncertainty protects the epistemic setting by positioning the failure to locate a diagnosis in the individual, rather than in the medical paradigm.

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Diagnostic uncertainty and epistemologic humility

Cited by 20 publications

References 43 publications

Scleroderma as an uncommon cause of pericardial effusion: a case report

Scleroderma as an uncommon cause of pericardial effusion: a case report

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Uncertainty and the inconvenient facts of diagnosis

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