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Biomedical subjects

F Wolfe

Publications and source records attributed to F Wolfe.

At least 37 records · Page 2Linked to original sources
PubMed2001

Lessons from an international survey of paper cases of 10 real patients from an early arthritis clinic. CRI (Club Rhumatismes et Inflammation) Group.

OBJECTIVE: To determine how experts would classify 10 early-arthritis cases (7 atypical) and to study discrepancies in diagnoses relative to ACR criteria for rheumatoid arthritis (RA) or ESSG criteria for spondyloarthropathy (SpA). METHODS: Ten real cases (5 met ACR criteria for RA, 6 ESSG criteria for SpA, 3 both and 2 neither) followed for 28.5 +/- 4.8 months were sent as paper cases to 20 international and 12 French experts. Each expert selected a diagnosis among 8 possible choices and rated it on a 0-10 confidence scale. For each case, 3 analog scales (0-100 mm) were used to indicate the probability of RA, SpA or undifferentiated arthritis (UA). RESULTS: Experts often disagreed about diagnoses (up to 5 different diagnoses for a given case, with a mean of 3.9 per case). Similarly, expert opinions on probabilities for RA and SpA differed widely, with great overlap between confidence for RA, SpA and UA. Fulfilment of ACR or ESSG criteria was poorly related to the experts' diagnosis and evaluation of probabilities for RA and SpA. However, UA was a relatively infrequent choice (19%). CONCLUSIONS: There was no general consensus about the nosology of early RA and SpA. Classification of atypical early arthritis was not resolved by currently available criteria for RA and SpA. This may have implications for therapy in early disease.

Adult↗
PubMed2001

Which HAQ is best? A comparison of the HAQ, MHAQ and RA-HAQ, a difficult 8 item HAQ (DHAQ), and a rescored 20 item HAQ (HAQ20): analyses in 2,491 rheumatoid arthritis patients following leflunomide initiation.

OBJECTIVE: To determine whether the full Health Assessment Questionnaire (HAQ), the shortened modified HAQ (MHAQ), or the new shortened RA-HAQ, developed on the basis of Rasch item response theory (IRT), performs best in terms of distributional characteristics, detection of functional loss, and identification of change in functional status in patients with active rheumatoid arthritis (RA). METHODS: A total of 2,491 clinic patients with RA with active disease from the practices of 519 US rheumatologists were assessed by questionnaire at the time leflunomide was started and at subsequent followup when there had been sufficient time for response. RESULTS: The HAQ scores were almost normally distributed along the 0-3 scale, but 95% of MHAQ and RA-HAQ values were clustered between 0 and 1.5. Normal or minimally abnormal scores (0 or 0.125) were noted in 6.6% of HAQ but in 21-22% of MHAQ/RA-HAQ. Mild functional loss (< or =0.375) was found in 12.7, 39.1, and 36.1% of patients by the HAQ, MHAQ, and RA-HAQ, respectively. This indicates that the MHAQ and RA-HAQ generally fail to identify appropriately the extent of functional loss in RA. The HAQ was significantly better at detecting changes than the MHAQ or RA-HAQ, with relative efficiencies of 1.28 and 1.37 compared to the MHAQ and RA-HAQ, respectively. This results in roughly a 20-26% reduction in sample size requirements. Two additional HAQ were identified that performed better than the HAQ itself, a 20 item HAQ without the use of aids and devices and an 8 item HAQ composed of the most difficult item in each of the 8 HAQ subscale categories. CONCLUSION: The HAQ is better (more efficient) than the MHAQ or RA-HAQ at detecting treatment change, and identifies the extent of functional disability better than the shortened questionnaires. The 3 questionnaires have different means, sensitivities, and distributional properties and cannot be thought of as simply different versions of the same questionnaire. The benefits of the MHAQ and RA-HAQ are that they are short and easier to score. But these benefits come at the price of loss of sensitivity and loss of sensitivity to change. The 20 item HAQ and the difficult 8 item HAQ are intriguing additional choices that are worthy of further study.

Aged↗
PubMed2001

Evaluating severity and status in rheumatoid arthritis.

There is general agreement regarding the most appropriate examinations and methods to use to evaluate change in status in randomized controlled trials (RCT). However, no guidelines exist to aid in determining and evaluating actual status rather than change in status, particularly when applied to individual patients with rheumatoid arthritis (RA). In addition, methods appropriate for clinical trials may not be useful in evaluating individual patients because of time constraints. This report reviews current methods of evaluation and develops modified methods, based on data bank research that will be useful in clinical practice and in the evaluation of RCT and observational studies. Using data from longitudinal observational data banks, further reduction in the number of joints examined is evaluated to reconcile the time constraints of clinical practice with the need to maintain reliability and validity. Percentile methods to determine severity status are applied to the variables used in RCT and extended further to observational studies and routine clinical practice. Shortened joint counts, based on modifications of the Ritchie method, are identified that allow for examination of groups of 18 (clinical-18) and 16 (clinical-16) joints, the clinical-16 omitting the metatarsophalangeal joints. Using percentile charts, actual severity valuations are given to the variables evaluated in the clinic as well as in RCT. Disease activity status of clinic patients can be determined quantitatively thus allowing clinicians further insight into the status and prognosis of their patients. By quantifying disease activity severity, clinicians and 3rd party payers can better evaluate the appropriateness of and response to disease modifying antirheumatic drugs and biologic therapies. Further, RCT can be evaluated as to severity status of patients participating, and the generalizability of RCT can be better evaluated.

Arthritis, Rheumatoid↗
PubMed2001

Starting a disease modifying antirheumatic drug or a biologic agent in rheumatoid arthritis: standards of practice for RA treatment.

Our aim was to investigate the practices and standards by which disease modifying antirheumatic drugs (DMARD) and biologics are and have been prescribed. We reviewed the literature and examined data from patients with rheumatoid arthritis (RA) participating in a national cohort: the National Data Bank for Rheumatic Diseases (NDB). Four pathways for DMARD prescription were identified: (1) A time-based pyramidal approach (the RA pyramid); (2) a severity-based pyramid in which the most effective treatment is given to those with more active disease; (3) a cost-based pathway in which the primary goal is cost containment--this pathway intertwines with the severity-based pathway; and (4) a patient preference pathway where treatment is geared to patient needs and wishes regardless of severity. Data show that the time-based and severity-based pathways are not generally used in contemporary expert practice, and that patients with all degrees of severity and disease duration are receiving DMARD and biologic treatment. With the abandonment of the pyramid and the development of effective therapy, rheumatic disease care has swung away from the imperative of time and severity-based treatment to the imperative of care based on patient preference. It is the standard of practice to treat patients with mild and early disease with aggressive therapy, with the goal of limiting subsequent damage and retarding progression, and with the realistic purpose of relieving symptoms. The standard may at times be in conflict with the goals of insurers, but there is no legitimate medical reason for such limitations.

Antirheumatic Agents↗
PubMed2001

Evaluation and documentation of rheumatoid arthritis disease status in the clinic: which variables best predict change in therapy.

To determine in clinical practice which rheumatoid arthritis (RA) clinical status variables are most associated with a change in disease modifying antirheumatic drug (DMARD) therapy, we studied 26,240 observations from 1905 RA patients occurring over 25 years. Variables included tender joint count, erythrocyte sedimentation rate (ESR), grip strength, visual analog scale for pain, global severity, fatigue and sleep, Health Assessment Question functional disability scale (HAQ), anxiety, depression and morning stiffness. Only the tender joint count required a physician. Observations at which a change in DMARD therapy occurred were compared to those where a change did not occur using generalized estimating equations (GEE) and classification and regression tree analysis (CART). Tender joint count, pain, global severity, and ESR were the 4 variables most strongly predictive of DMARD change. CART modeling indicated a special role for fatigue and sleep disturbance in some patients. These data add support in clinical practice for the ACR core set and the DAS set of variables. In addition, they validate the use of these variables in a practice setting. We suggest a minimum set of evaluations comprising: joint count, ESR or CRP, measures of pain and/or severity, a fatigue scale (fatigue being a surrogate for sleep disturbance), and a measure of function such as the HAQ or modified HAQ. Because only joint count requires physician participation, these evaluations are practical for the clinic, and allow quantitative measurement of RA status. With the use of quantile charts, the comparative status of RA and the change in RA status can be determined easily.

Adult↗
PubMed2001

The level of inflammation in rheumatoid arthritis is determined early and remains stable over the longterm course of the illness.

OBJECTIVE: To determine whether the level of inflammatory activity, determined by the erythrocyte sedimentation rate (ESR), changes over the longitudinal course of rheumatoid arthritis (RA); whether the level of inflammatory activity identified early in RA predicts longterm inflammatory status; and whether RA "bums out" after many years of inflammatory activity. METHODS: A total of 21,866 consecutive ESR determinations from 1,897 patients with RA were analyzed to determine the association of inflammatory activity, as estimated by ESR, with duration of disease. Data were modeled by generalized estimating equations and random selection fractional polynomial regression models, controlling for age, sex, and calendar date. RESULTS: In a nonlinear fashion, ESR decreased by 4 mm/h over the first 10 years of disease, remained stable over the next 25 years, and increased slightly thereafter. Patients treated more recently had lower ESR values. Patients with recent onset of RA, when stratified in quartiles of ESR, maintained their position over time. CONCLUSION: Although ESR decreases by 4 mm/h over the first 10 years of disease, it remains stable or rises thereafter. The course of RA, as modeled by the ESR, appears to be "set" early in the disease and good and bad prognosis groups can be identified within the first 2 years. There is no evidence of general "burned out" RA or a lessening of disease activity with long duration of disease. Our findings tend to suggest that the ("usually treated") natural history of RA prior to introduction of antitumor necrosis factor agents is toward some degree of improvement in the early years. If the newer and combination therapies are indeed substantially better than what has been available, they must show a shifting of the curve downward, not just in the early years where it has occurred historically, but over the entire course of the illness.

Adult↗
PubMed2001

Seasonal symptom severity in patients with rheumatic diseases: a study of 1,424 patients.

OBJECTIVE: To examine the nature of seasonal symptoms, their prevalence, and differences among rheumatic disorders by examining longitudinal data over a period of up to 24 years. METHODS: We used a questionnaire assessment of seasonal symptoms using the Seasonal Pattern Assessment Questionnaire (SPAQ) in 1,424 patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Clinical status was evaluated with standard assessment measures, and reported symptoms were compared with actual seasonal differences measured for periods of up to 24 years. RESULTS: About 50% of patients with rheumatic disease reported exacerbation of rheumatic symptoms (pain, global severity, and fatigue) by seasonal changes. The presence of seasonal symptoms was not related to diagnosis or to seasonal affective disorder (SAD) symptoms, and symptoms were less common in older patients and in men. The number of symptoms and the severity of allied factors (depression, anxiety, pain, global severity, number of months with seasonal symptoms) were increased in persons with FM and/or complete SAD symptoms. Using circular statistics, the modal months for worse symptoms were December and January, and for best symptoms was July. Bimodal patterns of seasonality were identified for global severity, joint pain, fatigue, and socialization. Seasonal symptoms differed as to the degree at which they were dispersed around the 12 month circle. When pain and global severity measurements obtained over a 24 year period were analyzed, pain was slightly increased in the summer and global severity was not related to season at all. Even when patients who specifically reported worse symptoms in winter and best symptoms in summer were examined, no effect of season could be found. CONCLUSION: Seasonal rheumatic symptoms are commonly reported across all rheumatic diseases, but appear to reflect perception rather than reality since reported symptoms do not agree with measured clinical scores. In addition, regardless of seasonal complaints, measured pain and global severity scores are not worse in winter. Although patients with FM and Season (+) patients report more severe symptoms, their pattern of reporting and their actual scores do not differ according to season compared to persons without FM or positive seasonality.

Adult↗
PubMed2000

Preference for nonsteroidal antiinflammatory drugs over acetaminophen by rheumatic disease patients: a survey of 1,799 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia.

OBJECTIVE: Because there is controversy regarding the efficacy of acetaminophen in rheumatic diseases and because apparently safer nonsteroidal antiinflammatory drugs (NSAIDs) are being produced, we surveyed rheumatic disease patients about their preferences for these agents to determine the degree to which one type of therapeutic agent is preferred over the other. METHODS: In 1998, we surveyed by mailed questionnaire 1,799 patients with osteoarthritis (OA), rheumatoid arthritis, or fibromyalgia who were participating in a long-term outcome study. Patients who had taken acetaminophen rated the effectiveness of acetaminophen, compared its effectiveness with that of NSAIDs, and then rated their overall satisfaction with acetaminophen compared with NSAIDs when both effectiveness and side effects were considered. RESULTS: Two-thirds of study participants had taken acetaminophen. About 37% of patients who had taken acetaminophen found it to be moderately or very effective and about 63% indicated that it was not effective or was only slightly effective. One-fourth of the patients found acetaminophen and NSAIDs to be equally effective, but >60% found acetaminophen to be much less effective or somewhat less effective. About 12% preferred acetaminophen to NSAIDs. When both effectiveness and side effects were considered together, 25% of the patients had no preference, 60% preferred NSAIDs, and 14% preferred acetaminophen. CONCLUSION: There was a considerable and statistically significant preference for NSAIDs compared with acetaminophen among the 3 groups of rheumatic disease patients. Although this preference decreased slightly with age and was less pronounced in OA patients, the preference was noted among all categories of patients and was not altered by disease severity. If safety and cost are not issues, there would hardly ever be a reason to recommend acetaminophen over NSAIDs, since patients generally preferred NSAIDs and fewer than 14% preferred acetaminophen. If safety and costs are issues, then the recommendation of the American College Rheumatology that acetaminophen be tried first seems correct, since 38.2% found acetaminophen to be as effective or more effective than NSAIDs.

Acetaminophen↗
PubMed2000

A reappraisal of HAQ disability in rheumatoid arthritis.

OBJECTIVE: To investigate the course of self-reported disability in rheumatoid arthritis (RA) using the major self-report measure of functional impairment, the Health Assessment Questionnaire (HAQ). METHODS: The course of HAQ disability was assessed in 32,525 observations (1,843 patients) in which the HAQ was administered. In addition, a subset of 2,189 visits from 50 patients, followed on average for 17 years, was studied to model the effect of disease duration on the course of HAQ disability in individual patients. Linear and fractional polynomial regression as well as smoothing algorithms were applied to the group of RA patients and then to the individual course of patients. RESULTS: Group linear and nonlinear models of the effect of disease duration on HAQ disability were found to have 3 characteristics: 1) HAQ disability scores are high at disease onset rather than gradually increasing; 2) HAQ disability increases very slowly over time (0.03 units per year); and 3) all such models fit very poorly, explaining only 5% of the variance in HAQ disability scores. However, application of nonlinear models to individual patient courses (as opposed to groups of patients) explains 37% of the HAQ disability score variation. In some patients, the course of HAQ disability was either 1) chaotic (scores change without any pattern) or 2) determinable, but unrelated to time. When covariates were added to the group model, however, the course of HAQ disability became clearer, and 51% of the variance in the disability score could be explained, statistically, by pain, depression, erythrocyte sedimentation rate, and disease duration. CONCLUSION: Individual RA patients have differing, characterizable courses: 1) nonlinear, 2) chaotic, or 3) non-time determined. The model that self-reported physical disability, as measured by the HAQ, occurs as a function of disease acting over time does not fit the data well and is an inadequate model. This discrepancy may also be the result of the patient's upward reappraisal of functional ability with increasing time. The predominant determinants of HAQ disability in RA are disease activity, pain, and psychosocial factors rather than structural abnormality. Although the HAQ is a useful clinical tool and a central measure of disease outcome, it measures both process and outcome, and usually more process than outcome. Individual patient models that include all that is known about the patient--the paradigm of clinical care-may be a more effective way to examine the course of RA than are conventional group-based models.

Adult↗
PubMed2000

The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis.

OBJECTIVE: (1) To determine the degree to which rheumatoid factor (RF) positivity is associated with smoking; (2) to determine the quantitative effect of smoking and smoking length on the concentration of RF in all patients, and, in the seropositive patients separately, determining if a "dose-response" effect exists; (3) to investigate these relationships in men and women to clarify whether the effect of smoking is similar in both sexes; (4) to determine the effect of smoking, controlling for RF, on a variety of measures of disease status, severity, and activity. METHODS: Six hundred ten consecutive patients with rheumatoid arthritis seen for routine clinical care provided information on their smoking history. All underwent a complete joint examination, completed a series of health status questionnaires, provided information concerning pulmonary illnesses, underwent determinations for RF and erythrocyte sedimentation rate (ESR), and had hand radiographs. RESULTS: RF concentration was linearly related to the number of years smoked. This association was present in both sexes, but was stronger in men. Smoking was similarly related to rheumatoid nodule formation. A nonlinear relationship was found between smoking and radiographic abnormalities as determined by the Larsen method, even controlling for RF. Similarly, pulmonary illness was independently related to smoking and RF. No effect of smoking was seen on disease process variables such as ESR, pain, joint count, global severity, or functional ability. CONCLUSION: Quantitative relationships exist between smoking extent and RF positivity, RF concentration, nodule formation, radiographic progression, and pulmonary disease. These 3 latter effects are independent of RF positivity or concentration. Smoking does not contribute to alterations in disease activity measures, but appears to play a role in overall severity of disease.

Aged↗
PubMed2000

Modeling therapeutic strategies in rheumatoid arthritis: use of decision analysis and Markov models.

OBJECTIVE: The management of patients with rheumatoid arthritis (RA) is controversial, with a number of different proposed treatment strategies based on different conceptions of the natural history of the disease and different interpretations of the efficacy and effectiveness of the drugs used for treatment. We attempted to develop a theoretical framework to assess the effectiveness of different treatment regimens for RA. METHODS: We used decision analysis to structure the problem of comparing sequential monotherapy to a combination strategy. Subsequently, we used 3 different estimates of drug effectiveness: one from expert rheumatologists; a metaanalysis; and a recent nationwide survey of American rheumatologists, in a Markov model. Last, we utilized published duration of therapy data to model drug treatment over time. RESULTS: Estimates of drug effectiveness differed substantially among rheumatologists, but regardless of the estimates and the treatment strategy used, the model predicted over 90% of patients improved by the 3rd drug trial. Over time, treatment patterns in our model resemble the "sawtooth" pattern previously observed. CONCLUSION: Treatment strategies in RA are difficult to model because of uncertainty in both the structure of the model and the data needed to perform the analysis. These models tend to overestimate the effectiveness of drug sequences because of nonindependence between therapies, probably due to sequence effects, a change in responsiveness over time, or resistant subgroups. Our preliminary analysis suggests that the most effective agent, possibly methotrexate, should be used first if the objective is to get as many patients into remission as quickly as possible.

Arthritis, Rheumatoid↗
PubMed2000

Gastrointestinal symptoms and health related quality of life in patients with arthritis.

OBJECTIVE: To evaluate the relationship between gastrointestinal (GI) symptoms and health related quality of life (QOL) in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: A total of 1773 patients with arthritis participating in a longterm outcome study (OA of the hip or knee = 648, RA = 1125) completed mailed surveys that included assessments of GI symptoms and overall GI symptom severity, Short Form-36, the visual analog scale (VAS) for the EuroQol (Health QOL), a VAS global disease severity scale, and measures of disease and psychological status. The overall response rate exceeded 85%. RESULTS: Dyspepsia (heartburn, bloating, or belching) and upper abdominal/epigastric pain were identified as the most important GI contributors to reduction in QOL, and the simultaneous presence of both these symptoms was associated with lower QOL (54.5) compared to those without symptoms (70.9) on the 0-100 Health QOL scale. Similarly, those in the upper tertile of the global GI severity scale had Health QOL scores of 55.7 compared to 76.4 for those in the lower tertile. These differences in GI symptoms and GI severity, however, were reduced substantially when the effects of functional disability, pain, and depression were adjusted for: 62.3 to 68.6 (p = 0.003) and 63.7 to 70.3 (p<0.001) for the GI symptoms and GI severity scales, respectively. CONCLUSION: QOL is significantly impaired among unselected arthritis patients with GI symptoms compared to those without these symptoms. Dyspepsia and upper abdominal/epigastric pain are more strongly related to QOL measures than other GI symptoms, and are common among arthritis patients. It is possible to construct a simple scale of these 2 symptoms or to use the VAS GI severity scale and get a clinically useful idea of the current level of GI distress and alteration of QOL by GI problems. Two components of impairment can be identified, one that is smaller and unrelated to disease or psychological factors, and a second that is larger and includes these factors. Because GI symptoms can alter function, pain, and psychological status, it is likely that the true effect of GI symptoms on QOL is somewhere between the unadjusted and adjusted values cited above.

Adult↗
PubMed2000

The importance of gastrointestinal (GI) symptom severity in rheumatoid and osteoarthritis: symptom rates and risk for GI hospitalization.

OBJECTIVE: To determine the prevalence and stability of gastrointestinal (GI) symptoms in outpatients with rheumatoid arthritis (RA) and osteoarthritis (OA); to determine the specific symptoms that contribute to severity; and to determine the predictive value of GI symptoms and GI severity on the risk of future GI hospitalization. METHODS: A questionnaire survey was mailed to 1221 patients with RA and OA on a continuing 6 month schedule. Patients completed an average of 4.4 questionnaires (n = 5,047). Questionnaires included a visual analog scale GI severity scale, and questions regarding GI hospitalizations and specific GI symptoms. Hospitalizations that were reported as relating to the GI system were audited by checking hospital records. RESULTS: We found 57.5%, 40.2%, and 25.5% of patients had at least one assessment in which they had a GI symptom severity of 0.25-0.99, 1.00-1.99, and 2.00 or greater, respectively. Overall 74.9% had at least one score of 0.25 or greater, and 73.6% had one score of < 0.25, the cutoff for GI symptoms. By contrast, 6.45% had a GI hospitalization, and in only 0.75% of the questionnaire assessments were hospitalizations noted. Pyrosis and peptic ulcer symptoms were common, and were found in 62.5% and 42.4% of patients and 28.2% and 12.9% of observations, respectively. Among patients reporting GI severity scores between 2 and 3, roughly 60% and 45% reported the presence of pyrosis and peptic ulcer symptoms, respectively. The presence of a GI severity score > or = 0.25 was associated with 2.8-3.0-fold increase in the risk of hospitalization over the following 6 months. CONCLUSION: These data suggest that symptoms have an importance of their own that relates to quality of life, regardless of the risk of serious GI events like hospitalization, and that more attention should be placed on symptoms and symptom severity in future research. In spite of the statistical predictive value of GI symptom severity on future hospitalizations, it is important to recognize that rate of GI hospitalization increases from 0.92 per 100 patient-years to only 2.90 per 100 patient-years when the GI symptom scale goes from approximately zero to positive values. Thus, in spite of its statistical predictive ability, GI symptom severity is a poor clinical predictor of the hospitalizations that occur in patients with rheumatic diseases. Instead, GI symptom severity and specific GI symptoms have a separate importance to patients.

Arthritis, Rheumatoid↗
PubMed2000

The comparative risk and predictors of adverse gastrointestinal events in rheumatoid arthritis and osteoarthritis: a prospective 13 year study of 2131 patients.

OBJECTIVE: It has been suggested that rheumatoid arthritis (RA) itself may be a risk factor for adverse gastrointestinal (GI) events, but this hypothesis has not been studied in a large sample, nor has the effect of time on risk factors been studied. We investigated rates and risk factors for GI events in RA and osteoarthritis (OA) and assessed the additional risks conveyed by having RA. METHODS: A prospective study of patients with OA and RA from a single center was undertaken using questionnaires mailed at 6 month intervals. The relationship between drug therapy and GI events was assessed in the same 6 month time frame. Over 13 years of biannual assessments, 2,131 patients were studied for serious GI events and adverse GI symptoms during 9,621 patient-years of observation. RESULTS: The incidence rate (IR) for GI hospitalization was 1.56 and 1.28 per 100 patient-years, and for GI bleeding or perforation was 0.50 and 0.58 for RA and OA, respectively. After controlling for age, sex, nonsteroidal antiinflammatory drug (NSAID) and steroid use, the incidence rate ratio (IRR) for RA versus OA did not differ for hospitalization [IRR 1.07 (95% CI 0.66, 1.74)] or for bleeding or perforation [IRR 0.63 (95% CI 0.29, 1.35)]. In multivariate analyses for both groups combined, the IRR was 2.95 (2.05, 4.24) for prednisone use, 1.41 (1.08, 1.85) for NSAID use, and 1.46 (1.22, 1.74) for every 10 year increase in age. In additional multivariate models, Health Assessment Questionnaire disability was also a significant risk factor. During the study period, the odds of NSAID use decreased 2.94 times per 10 year period, while the odds of prednisone use increased by 1.49. Dysphagia [IRR 1.11 (1.00, 1.24)], anorexia [IRR 1.13 (1.03, 1.23)], nausea [IRR 1.13 (1.04, 1.25)], heartburn [IRR 1.12 (1.05, 1.19)], vomiting [IRR 1.20 (1.02, 1.42)], peptic ulcer symptoms [IRR 1.20 (1.11, 1.29)], and abdominal pain [IRR 1.11 (1.01, 1.22)] were associated with NSAID use, but not with steroids. CONCLUSION: Patients with RA and OA do not differ in the rates and risk factors for GI hospitalizations and symptoms after controlling for age, steroid use, NSAID use, or (for OA) body mass index. Prednisone is a more important risk factor among patients with RA than NSAID.

Adrenal Cortex Hormones↗
PubMed2000

The assessment of functional impairment in fibromyalgia (FM): Rasch analyses of 5 functional scales and the development of the FM Health Assessment Questionnaire.

OBJECTIVE: Functional assessment by self-report questionnaire plays an important role in most rheumatic conditions, but psychometric properties of questionnaires have not been studied in fibromyalgia (FM), particularly by Rasch analysis, which allows for examining adequacy of the questionnaire scale. To assess currently used instruments, we examined the Fibromyalgia Impact Scale (FIQ), 4 versions of the Health Assessment Questionnaire (HAQ), and the Medical Outcome Survey Short Form (SF-36). METHODS: More than 2,500 patients from 4 sites (3 US, 1 Israel) completed the FIQ. The HAQ questionnaires were completed by 1438 patients participating in the US National Data Bank for Rheumatic Diseases. Seven hundred sixty patients from Wichita, Kansas, completed the SF-36. Rasch analysis was applied separately to each of these data sets. RESULTS: The FIQ systematically underestimated functional impairment by its handling of activities not usually performed. All questionnaires had problems with non-unidimensionality and ambiguous items when applied to patients with FM. In addition, scales were found to be non-linear. Because of these findings we used the 20 item HAQ questionnaire as an item bank to develop a new questionnaire more suitable for use in FM, the fibromyalgia HAQ (FHAQ). This questionnaire fits the Rasch model well, is relevant, is linear, and has a long, well spaced scale. CONCLUSION: No available functional assessment questionnaire works well in FM. A new questionnaire, the FHAQ, was developed. It has appropriate metric properties and should function well in this condition. Since the FHAQ is a subset of the larger HAQ questionnaire, a new questionnaire is not required; only a different method of scoring is needed. Additional studies regarding sensitivity to change are required to fully validate the FHAQ.

Disability Evaluation↗