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Biomedical subjects

F Wolfe

Publications and source records attributed to F Wolfe.

At least 19 recordsLinked to original sources
PubMed1992

The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis.

OBJECTIVE: To develop and validate revised criteria for global functional status in rheumatoid arthritis (RA). METHODS: Revised criteria were formulated and tested for criterion and discriminant validity in 325 patients with RA. RESULTS: The revised criteria developed are as follows: class I = able to perform usual activities of daily living (self-care, vocational, and avocational); class II = able to perform usual self-care and vocational activities, but limited in avocational activities; class III = able to perform usual self-care activities but limited in vocational and avocational activities; class IV = limited in ability to perform usual self-care, vocational, and avocational activities. Usual self-care activities include dressing, feeding, bathing, grooming, and toileting; vocational and avocational activities are both patient-desired and age-, and sex-specific. The distribution properties of this classification schema were superior to those of the original Steinbrocker criteria. Mean Health Assessment Questionnaire scores were significantly (P less than 0.0001) different between, and increased across, the 4 classes. CONCLUSION: Although there are limitations inherent in the use of global ordinal scales, the American College of Rheumatology revised criteria will be useful in describing the functional consequences of RA. A more detailed quantitative measure of physical disability should be used, however, for optimal monitoring of patients' clinical status in office practice and clinical research.

Activities of Daily Living↗
PubMed1992

Sensitivity to change of the health assessment questionnaire (HAQ) and other clinical and health status measures in rheumatoid arthritis: results of short-term clinical trials and observational studies versus long-term observational studies.

To obtain evidence concerning short-term and long-term efficacy of clinical and health status measures in rheumatoid arthritis (RA), we conducted two observational studies--a 6-month study of 233 patients receiving methotrexate and a 10-year study of 157 patients receiving multiple treatments in a rheumatic disease clinic. Results of the 6-month study yielded effect sizes for treatment similar to the meta-analyses reported by Felson [corrected] et al. (Arthritis Rheum 33:1449-1461, 1990) and the controlled trials of methotrexate reported by Weinblatt et al. (Arthritis Rheum 33:330-338, 1990), suggesting that observational studies provide valid measurements of treatment effect. The effect size for the Health Assessment Questionnaire (HAQ) was 0.5. By contrast, the 10-year study suggested that standard clinical variables changed little and were not useful in assessing RA outcome, while the effect size of the HAQ was -2.39. These data continue to underscore the differences between short-term trials and the long-term outcome of RA, and suggest an important place for the HAQ or similar instruments in all phases of RA evaluation and assessment.

Arthritis, Rheumatoid↗
PubMed1992

The sense of coherence questionnaire in patients with rheumatic disorders.

Aaron Antonovsky's Sense of Coherence (SOC) questionnaire with its 3 subscales is designed to measure strengths within individuals that allow them to survive in the face of extreme stresses, including chronic illness. We administered the SOC to 1333 patients with rheumatic disorders. Although the instrument had high alpha reliability, factor analysis did not support the concept of distinct subscales. The SOC was strongly related to the Arthritis Impact Measurement Scales anxiety and depression scores (r = -0.63 to -0.69), less strongly related to clinical variables (r = -0.20 to -0.33), and was minimally related to demographic variables. When psychological variables were controlled for, almost no association between the SOC and clinical variables remained (r = 0.06). Whether the SOC will be more useful than standard psychological instruments awaits the result of ongoing studies.

Adaptation, Psychological↗
PubMed1992

The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease.

Four experts on myofascial pain syndrome (MFP) performed trigger point examinations and 4 experts on fibromyalgia performed tender point examinations on 3 groups of subjects (7 patients with fibromyalgia, 8 with MFP, and 8 healthy persons) while blinded as to diagnosis. Local tenderness was common in both disease groups (65-82%), but was elicited in a greater proportion of MFP experts' examinations (82%). Active trigger points were found in about 18% of examinations of patients with fibromyalgia and MFP, but latent trigger points were rare in all groups. A more liberal definition of trigger point, however, resulted in a 38 and 23% positive rate among patients with fibromyalgia and MFP, respectively. Taut muscle bands and muscle twitches were common (50 and 30%, respectively) and noted equally in all 3 diagnostic groups. Problems with reliability were identified for taut bands, muscle twitch, and active trigger points. Our data are exploratory and tentative, but suggest that attention to definition and reliability are required to advance our knowledge of these common syndromes.

Fibromyalgia↗
PubMed1991

The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first twenty-five years of disease.

Erosions and cartilage destruction are nearly universal features in peripheral joints that have been chronically affected by rheumatoid arthritis. Scoring methods to measure the extent of these abnormalities in hands and wrists have been developed and have been thoroughly tested in several studies to establish their reproducibility. In this study, we utilized one of these scoring methods to examine the progression of radiologic damage as related to duration of disease. Two hundred ninety-two patients from 3 different participating centers in the Arthritis, Rheumatism, and Aging Medical Information System were included. Six hundred fifty films of the hands and wrists, obtained from 210 patients, were scored for erosions and joint space narrowing. The average annual rate of progression of the total radiologic score, which sums erosion and joint space abnormalities and has a maximum possible score of 314, was approximately 4 units per year over the first 25 years after onset; this progression was more rapid in the earlier years of disease and slightly slower in the later years. Data were insufficient to accurately determine the progression rate in disease of more than 25 years duration.

Arthritis, Rheumatoid↗
PubMed1991

The latex test revisited. Rheumatoid factor testing in 8,287 rheumatic disease patients.

Rheumatoid factor (RF) testing by latex fixation in 8,287 outpatients yielded a sensitivity of 81.6% and 78.0% at titers of 1:20 and 1:80, respectively, and a specificity against noninflammatory rheumatic disorders (NIRD) of 96.6% and 97.9% and against NIRD plus inflammatory disorders of 95.2% and 96.8%, respectively. The predictive value of a positive test result at the clinic prevalence rate for rheumatoid arthritis (RA) (16.4%) was approximately 80%, and was 70% at 10% prevalence and 10% at 1% prevalence. No associations of RF with age or sex were found in non-RA patients. RF titers increased minimally with age in RA patients and were higher in men than in women. This study suggests that latex testing is far more specific than has been believed and that the titer is not spuriously increased with age.

Adult↗
PubMed1991

The epidemiology of NSAID associated gastrointestinal disease.

Many problems make it difficult to estimate the exact risk of peptic ulceration and its complications, perforation and bleeding, in patients receiving NSAIDs. Nevertheless the association of these events and treatment is now beyond dispute. Deaths are a particular problem in the elderly since mortality from peptic ulcer disease rises steeply after age 60. Risk factors identified with hospitalisation for gastrointestinal problems in patients receiving NSAIDs include age, previous gastrointestinal symptoms, corticosteroid use and disability. The risk of death is highest in elderly females and is substantial.

Adolescent↗
PubMed1991

Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis.

We studied clinical and health status measures in 561 patients with rheumatoid arthritis (RA). Two hundred sixty-four patients were seen within 2 years of disease onset and followed for an additional 2 years. Four other groups were each followed for 5 years, and had disease durations of 2-7, 7-12, 12-17, and 17-22 years, respectively, at the first clinic visit. Functional disability developed very early in the course of RA and continued to worsen at about an equal rate over 22 years. Anxiety, pain scores, and self-assessed severity also increased with time, but erythrocyte sedimentation rate (ESR), morning stiffness, and joint counts were unchanged. Treatment resulted in reduction in joint counts and in nonsignificant improvements in ESR, stiffness, and psychological scores. But functional loss increased in each time period in spite of treatment. Variables most effective in controlled clinical trials are not effective as longterm measures of RA outcome.

Adult↗
PubMed1991

The assessment and prediction of functional disability in rheumatoid arthritis.

We assessed functional disability with the Stanford Health Assessment Questionnaire Functional Disability Index (FDI) in 1,274 patients with rheumatoid arthritis (RA) followed longitudinally for up to 12 years. The rate of functional loss increased sharply after the first clinic visit. Half of patients with RA (median survival time) will reach FDI scores of about 1 in 2 years, 2 in 6 years, and 2.5 in 10 years after the first clinic visit, levels that correspond to moderate, severe and very severe loss of functional ability. Functional outcomes may be predicted by simple demographic and clinical assessments, the best of which are self-assessed measures of global severity, pain and function.

Adult↗
PubMed1991

Pain, disability, and pain/disability relationships in seven rheumatic disorders: a study of 1,522 patients.

We studied the pain, Stanford Health Assessment Questionnaire functional disability, pain/disability ratio, and psychological scores in 1,522 patients with rheumatic disease with 7 distinct disorders. Individual differences between patients were more striking than differences among diagnostic groups. Patients with rheumatoid arthritis (RA) had the greatest disability, least pain, lowest pain/disability ratio, and least abnormal psychological scores. Highest pain and psychological distress was noted in low back pain, neck pain, and fibromyalgia (axial disorders). Disability in activities of daily living was as high in fibromyalgia as in RA, but low in axial skeletal disorders. There appears to be a continuum for disability that begins with axial but not articular disease (neck and back pain) and ends with multiple articular and periarticular involvement (RA and fibromyalgia).

Adult↗
PubMed1991

Methotrexate in rheumatoid arthritis: effects on disease activity in a multicenter prospective study.

One hundred and twenty-three patients with rheumatoid arthritis (RA) who successfully completed a randomized trial comparing oral methotrexate (MTX) to auranofin enrolled in a longterm prospective study of oral MTX. Of the 91 patients who completed 24 months of therapy, a significant (p = 0.0001) improvement was noted compared to baseline in all clinical disease variables and the Westergren erythrocyte sedimentation rate (ESR). Marked improvement occurred in 94 (76%) and 98 (80%) of the patients in the joint pain/tenderness index and joint swelling index at the last evaluable visit (mean 26 months). Of the 77 patients with an elevated ESR at baseline, 29 (38%) patients normalized it (less than 20 mm/h) while receiving therapy (p less than 0.01). A significant reduction in prednisone dose was also seen. Adverse events occurred frequently but were generally mild in severity. Twenty-seven patients (22%) withdrew during the study. Four (3%) withdrew due to lack of efficacy, and 6 (5%) because of adverse experiences. The overall probability of continuing therapy in the study for 48 months was projected at 72%. This large prospective study supports the observation of earlier smaller studies that MTX is an effective drug in the treatment of RA.

Administration, Oral↗
PubMed1991

Marital status in rheumatoid arthritis and other rheumatic disorders: a study of 7,293 patients.

Divorce has been considered to be increased in rheumatoid arthritis (RA), perhaps as a result of the stress of serious chronic illness. We studied marital status in 7,293 consecutive rheumatic disease patients attending an outpatient rheumatic disease clinic. Divorce was associated with age, sex, population size, and ethnic origin, but when these factors were controlled for, divorce was not more common in the 1,267 patients with RA. Age and sex adjusted divorce percentages for RA and non-RA patients were 6.9 and 6.8 compared with a U.S. percentage of 7.6. Patients with RA, however, were almost 5 times less likely to be remarried after divorce than patients with osteoarthritis.

Arthritis, Rheumatoid↗
PubMed1991

Analysis of methotrexate treatment effect in a longitudinal observational study: utility of cluster analysis.

We studied 235 patients with rheumatoid arthritis (RA) beginning therapy with methotrexate utilizing a k-means clustering algorithm. Four groups were identified: mild RA (Group 3), very severe RA (Group 4), and 2 groups intermediate in severity (Groups 1 and 2). Group 2, the largest of the clusters (n = 89), appeared to have greater tolerability of RA as measured by severity and psychological variables, and took the drug almost twice as long as other groups, although improvement was not greater nor side effects fewer. All groups improved over a mean of 1.9 years, and the degree of improvement was not related to the initial severity classification. Improvement occurred almost equally in all clusters, and the relative ranking of the groups was maintained at study closure.

Arthritis, Rheumatoid↗
PubMed1991

Are the results of controlled clinical trials and observational studies of second line therapy in rheumatoid arthritis valid and generalizable as measures of rheumatoid arthritis outcome: analysis of 122 studies.

We studied 122 controlled clinical trials and observational studies of second line therapy that involved 16,071 patients. The mean disease duration was 7.61 years at study entry. Controlled clinical trials were inherently short term, and 90.5% of patients were followed for 1 year or less (mean 8.8 months). The mean followup of observational studies was 31 months. Outcome assessments that included functional measurements were rare in either study type, as were considerations of socioeconomic factors. Except for methotrexate, which was used longer, half of the studies indicated discontinuation of therapy after 1.5 years. Good retention rates in studies of 3 to 12 months were not representative of longterm results, but controlled clinical trials and observational studies were similar as to retention during the first treatment year. Observational studies following controlled clinical trials can yield important information about RA treatment effectiveness not available from controlled clinical trials alone.

Anti-Inflammatory Agents↗
PubMed1991

The effect of age on methotrexate efficacy and toxicity.

We studied the clinical course of 235 patients with rheumatoid arthritis (RA) receiving methotrexate (MTX) over a mean of 1.9 years. Both older (greater than 65 years) and younger (less than or equal to 65 years) patients demonstrated clinical improvement, but older patients had greater improvement in erythrocyte sedimentation rate and hemoglobin than younger patients. Most assessments of laboratory abnormalities and symptoms suggestive of toxicity did not differ between age groups. But more gastrointestinal complaints and pulmonary complaints were reported in older patients, associations that have been noted in older patients not treated with MTX as well. Our data indicate that treatment that includes MTX is effective in older patients with RA, and that older patients improve at least as much as younger.

Adult↗