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Biomedical subjects

D T Felson

Publications and source records attributed to D T Felson.

At least 91 records · Page 5Linked to original sources
PubMed1998

Nonmedicinal therapies for osteoarthritis.

Given the modest efficacy of medicinal therapy for OA, nonpharmacologic therapy is popular. Convincing evidence exists to support the efficacy of exercise and muscle strengthening for patients with knee OA. Weight loss is likely to be effective, as are some types of biomechanical alterations, possibly including elastic knee supports and the use of canes and crutches. The clinical management of patients with OA should sample broadly from these treatments, especially because they may offer other health benefits as well (i.e., aerobic exercise and weight loss). The optimal use of these modalities requires a team approach to patient care, in which the physician works closely with a physical therapist and nutritionist. This integrated approach may lead to decreases in pain and disability for the patient with OA.

Exercise Therapy↗
PubMed1998

The association of peripheral monocyte derived interleukin 1beta (IL-1beta), IL-1 receptor antagonist, and tumor necrosis factor-alpha with osteoarthritis in the elderly.

OBJECTIVE: To examine the association of peripheral blood mononuclear cell (PBMC) derived interleukin 1beta (IL-1beta), IL-1 receptor antagonist (IL-1Ra), tumor necrosis factor alpha (TNF-alpha), and radiographic osteoarthritis (OA) in the elderly. METHODS: A total of 703 subjects (436 women, 267 men, mean age 78.5+/-4.5 yrs) had both knee and hand radiographs, and cytokines were measured during the 22nd biennial examination of the Framingham Cohort. PBMC derived IL-1beta , IL-1Ra, and TNF-alpha production was assessed using a non-cross reacting polyclonal radioimmunoassay. Knee OA was defined as a score of > 2 using a modified Kellgren and Lawrence scale. The presence of osteophytes and joint space narrowing were scored separately on a 0-3 scale, in which disease was defined a priori as a score > 0 for each feature. Sex-specific odds ratios were calculated for knee OA after adjusting for weight, history of knee injury, and use of estrogen and nonsteroidal antiinflammatory drugs. RESULT: No uniform associations were found for IL-1beta or IL-1Ra in men, or for TNF-alpha production and radiographic OA in either sex. We found possible associations for the highest levels of IL-1beta production and the presence of knee osteophytes [OR=2.0 (1.2-3.5)] and joint space narrowing [OR=1.7 (1.1-2.8)] in women. Our data suggested a possible protective effect for IL-1Ra production and hand OA in women [OR=0.6 (0.4-1.0)]. CONCLUSION: We found no consistent association of PBMC cytokine production and radiographic OA. However, women with the highest production of IL-1beta and IL-1Ra had respectively higher rates of knee OA and lower rates of hand OA than expected.

Aged↗
PubMed1997

Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham.

STUDY DESIGN: A 25-year follow-up study of 606 members of the population-based Framingham cohort, who had received lateral lumbar radiographs in 1967-1968 and 1992-1993, and completed an interview on back symptoms at the second examination. OBJECTIVES: To evaluate whether calcific lesions in the posterior wall of the abdominal aorta, the source of the feeding arteries of the lumbar spine, are associated with disc degeneration or back pain, which would suggest that ischemia of the lumbar spine leads to disc degeneration. METHODS: The presence of radiographic aortic calcification was ascertained in front of each lumbar segment from L1 through L4, and disc degeneration at intervertebral spaces from L1-L2 through L4-L5. The associations between aortic calcification, disc degeneration, and back pain were tested using logistic regression with adjustment for age and sex. RESULTS: At the baseline examination, aortic calcification was significantly associated with general disc degeneration, that is, disc space narrowing or endplate sclerosis at any lumbar level (odds ratio 1.6; 95% confidence interval 1.0-2.5; P = 0.034). In longitudinal, level-specific analyses, comparing local aortic calcifications with disc degeneration at the matching level, aortic calcifications predicted disc deterioration, that is, a decrease in disc space or appearance of endplate sclerosis, between the examinations (odds ratio 1.5; 95% confidence interval 1.3-1.8; P < 0.001). Furthermore, subjects in whom aortic calcifications developed between the examinations had disc deterioration twice as frequently as those in whom aortic calcifications did not develop (odds ratio 2.0; 96% confidence interval 1.2-3.5; P = 0.013). Also, individuals with severe (Grade 3) posterior aortic calcification in front of any lumbar segment were more likely than others to report back pain during adult life (odds ratio 1.6; 95% confidence interval 1.1-2.2; P = 0.014). CONCLUSIONS: Advanced aortic atherosclerosis, presenting as calcific deposits in the posterior wall of the aorta, increases a person's risk for development of disc degeneration and is associated with the occurrence of back pain.

Aged↗
PubMed1997

Bone mass and the risk of breast cancer among postmenopausal women.

BACKGROUND: Recent studies have shown a direct relation between serum estrogen levels assessed at a single point in time and the risk of breast cancer, but no evidence links estrogen levels assessed repeatedly over an extended interval to the risk of breast cancer. Bone mass has been proposed as a marker of cumulative exposure to estrogen in women. We therefore studied the association between bone mass and the incidence of breast cancer. METHODS: Between 1967 and 1970, 1373 women who were 47 to 80 years old and had no history of breast cancer underwent posteroanterior hand radiography in the Framingham Study. We used radiogrametry to measure the cortical width of each woman's second metacarpal. Participants were followed until the end of 1993. All incident cases of breast cancer were confirmed by pathological reports. We used a Cox proportional-hazards model to examine the relation of metacarpal bone mass to the risk of postmenopausal breast cancer. RESULTS: Postmenopausal breast cancer developed in 91 subjects. Incidence rates per 1000 person-years increased from 2.0 among the women in the lowest age-specific quartile of metacarpal bone mass to 2.6, 2.7, and 7.0 among the women in the second, third, and highest quartiles, respectively. After adjustments for age and other potential confounding factors, the rate ratios for the risk of breast cancer were 1.0, 1.3, 1.3, and 3.5 from the lowest quartile to the highest (P for trend, <0.001). CONCLUSIONS: Women in the highest quartile of bone mass are at higher risk for postmenopausal breast cancer than those in the lowest quartile. The mechanisms underlying this relation are not understood, but cumulative exposure to estrogen may play a part.

Aged↗
PubMed1997

Preliminary definition of improvement in juvenile arthritis.

OBJECTIVE: To identify a core set of outcome variables for the assessment of children with juvenile arthritis (JA), to use the core set to develop a definition of improvement to determine whether individual patients demonstrate clinically important improvement, and to promote this definition as a single efficacy measure in JA clinical trials. METHODS: A core set of outcome variables was established using a combination of statistical and consensus formation techniques. Variables in the core set consisted of 1) physician global assessment of disease activity; 2) parent/patient assessment of overall well-being; 3) functional ability; 4) number of joints with active arthritis; 5) number of joints with limited range of motion; and 6) erythrocyte sedimentation rate. To establish a definition of improvement using this core set, 21 pediatric rheumatologists from 14 countries met, and, using consensus formation techniques, scored each of 72 patient profiles as improved or not improved. Using the physicians' consensus as the gold standard, the chi-square, sensitivity, and specificity were calculated for each of 240 possible definitions of improvement. Definitions with sensitivity or specificity of <80% were eliminated. The ability of the remaining definitions to discriminate between the effects of active agent and those of placebo, using actual trial data, was then observed. Each definition was also ranked for face validity, and the sum of the ranks was then multiplied by the kappa statistic. RESULTS: The definition of improvement with the highest final score was as follows: at least 30% improvement from baseline in 3 of any 6 variables in the core set, with no more than 1 of the remaining variables worsening by >30%. The second highest scoring definition was closely related to the first; the third highest was similar to the Paulus criteria used in adult rheumatoid arthritis trials, except with different variables. This indicates convergent validity of the process used. CONCLUSION: We propose a definition of improvement for JA. Use of a uniform definition will help standardize the conduct and reporting of clinical trials, and should help practitioners decide if a child with JA has responded adequately to therapy. We are in the process of prospectively validating this definition and several others that scored highly.

Arthritis, Rheumatoid↗
PubMed1997

Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study.

OBJECTIVE: Knee osteoarthritis (OA) is highly prevalent, especially in the elderly. Preventive strategies require a knowledge of risk factors that precede disease onset. The present study was conducted to determine the longitudinal risk factors for knee OA in an elderly population. METHODS: A longitudinal study of knee OA involving members of the Framingham Study cohort was performed. Weight-bearing knee radiographs were obtained in 1983-1985 (baseline) and again in 1992-1993. Incident disease was defined as the occurrence of new radiographic OA (Kellgren and Lawrence grade > or = 2 on a 0-4 scale) in those without radiographic OA at baseline. Risk factors assessed at baseline and in the interim were tested in univariate and multivariate equations to evaluate their association with incident knee OA. RESULTS: Of 598 patients without knee OA at baseline (mean age 70.5 years, 63.7% women), 93 (15.6%) developed OA. After adjustment for multiple risk factors, women had a higher risk of OA than did men (adjusted odds ratio [OR] = 1.8, 95% confidence interval [95% CI] 1.1-3.1). Higher baseline body mass index increased the risk of OA (OR = 1.6 per 5-unit increase, 95% CI 1.2-2.2), and weight change was directly correlated with the risk of OA (OR = 1.4 per 10-lb change in weight, 95% CI 1.1-1.8). Physical activity increased the risk of OA (for those in the highest quartile, OR = 3.3, 95% CI 1.4-7.5). Smokers had a lower risk than did nonsmokers (for those who smoked an average of > or = 10 cigarettes/day, OR = 0.4, 95% CI 0.2-0.8). Factors not associated with the risk of OA included chondrocalcinosis and a history of hand OA. Weight-related factors affected the risk of OA only in women. CONCLUSION: Elderly persons at high risk of developing radiographic knee OA included obese persons, nonsmokers, and those who were physically active. The direction of weight change correlated directly with the risk of developing OA.

Aged↗
PubMed1997

Understanding the relationship between body weight and osteoarthritis.

Overweight people are at high risk of developing knee osteoarthritis (OA) and may also be at increased risk of hand and hip OA. Furthermore, being overweight accelerates disease progression in knee OA. While the increased joint stress accompanying obesity may explain the strong linkage between obesity and knee OA risk, it does not necessarily explain why obese people have a high risk of disease in the hand nor why obese women are at higher comparative risk of knee disease than obese men. Unfortunately, studies of metabolic factors linked to obesity have not provided an explanation for these findings. There are a paucity of data on weight loss as a treatment for OA, but preliminary information suggests it is especially effective in knee disease and that even small amounts of weight reduction may have favourable effects.

Body Weight↗
PubMed1997

Defining radiographic osteoarthritis for the whole knee.

OBJECTIVE: To determine in the knee which individual radiographic feature or combination of features in the patellofemoral and tibiofemoral joints correlate best with a nonradiographic definition of clinical osteoarthritis in order to recommend a definition of radiographic osteoarthritis for use in studies. METHODS: Using data from the Framingham Osteoarthritis Study, we tested the correlation of clinical OA, defined as frequent knee pain plus crepitus, with a variety of definitions of radiographic OA including those based on individual radiographic features, e.g. > or = grade 2 osteophyte 0-3 scale, and new definitions that included alternative combinations of features, [e.g. either > or = grade 2 osteophyte or joint space narrowing > or = grade 2 (0-3 scale) with a bone feature (such as cyst, sclerosis, or grade 1 osteophyte)]. We performed analyses looking at participants who had obtained both weight-bearing anteroposterior (AP) and lateral radiographs of both knees. RESULTS: In 519 participants, we found that the definitions of radiographic osteoarthritis best correlated with clinical OA were definite osteophyte > or = grade 2' (efficiency 62.4-67.1%) and an 'alternate definition' of either osteophytes > or = grade 2 or joint space narrowing > or = grade 2 with a bony feature of OA (efficiency 62.8-68.1%). A recursive partitioning analysis selected the 'alternate definition' as best. Also, we found that adding lateral views to the AP view improved the diagnostic test performance of the best performing radiographic definitions. CONCLUSION: We suggest that a knee should be characterized as having radiographic OA if there is either an osteophyte of grade 2 or greater severity (0-3 scale) present or the presence of moderate to severe joint space narrowing (> or = 2 on a 0.3 scale) with co-occurrence of a bony feature in the compartment affected.

Aged↗
PubMed1997

Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample.

This study describes the distribution and determinants of plasma 25-hydroxyvitamin D [25(OH)D] concentrations and risk factors for low 25(OH)D (< or = 37.5 nmol/L) in 290 men and 469 women aged 67-95 y who were in the Framingham Heart Study cohort. Mean (+/-SD) 25(OH)D concentrations were 82 +/- 29 nmol/L in men and 71 +/- 29 nmol/L in women. 25(OH)D was low in 6.2% of men and 14.5% of women. 25(OH)D concentrations were strongly associated with season of examination, inversely associated with time spent indoors and body mass index, and positively associated with dietary vitamin D intake. In women, concentrations were also inversely associated with age and positively associated with supplemental vitamin D intake and residence for > or = 3 mo/y in Florida, California, or Arizona, and in men were positively associated with serum creatinine concentrations. Similar amounts of variance in 25(OH)D concentrations were explained by vitamin D intake and sunlight exposure, the former being more important in women and the latter in men. None of the known or suspected determinants of vitamin D status could explain the lower 25(OH)D concentrations in women, but the sex difference was not seen for individuals examined during the winter. Results from this population-based sample of elderly individuals suggest that inadequate vitamin D status is an important public health problem, which could be readily addressed by adequate vitamin D intake or sunlight exposure.

Age Factors↗
PubMed1997

The BsmI vitamin D receptor restriction fragment length polymorphism (bb) influences the effect of calcium intake on bone mineral density.

Previous studies of the vitamin D receptor (VDR) polymorphisms and bone mineral density (BMD) have suggested that there may be differences in calcium absorption among groups of women with different VDR genotypes, and that the association may be stronger in younger women. To investigate the association between the VDR polymorphisms and BMD, this study was undertaken in the Framingham Study Cohort and a group of younger volunteers. Subjects from the Framingham Study (ages 69-90 years) included those who underwent BMD testing and who had genotyping for the VDR alleles (n = 328) using polymerase chain reaction methods and restriction fragment length polymorphisms with BsmI (B absence, b presence of cut site). A group of younger volunteer subjects (ages 18-68) also underwent BMD testing and VDR genotyping (n = 94). In Framingham Cohort subjects with the bb genotype, but not the Bb or BB genotypes, there were significant associations between calcium intake and BMD at five of six skeletal sites, such that BMD was 7-12% higher in those with dietary calcium intakes greater than 800 mg/day compared with those with intakes < 500 mg/day. The data also suggested that BMD was higher in persons with the bb genotype only in the group with calcium intakes above 800 mg/day. No significant differences were found in the Framingham Cohort for age-, sex-, and weight-adjusted BMD at any skeletal site between those with the BB genotype and those with the bb genotype regardless of 25-hydroxyvitamin D levels or country of origin. In the younger volunteers, BMD of the femoral neck was 5.4% higher (p < 0.05) in the bb genotype group compared with the BB group and 11% higher (p < 0.05) in males with the bb genotype compared with the BB group. There were no significant differences at the lumbar spine. In this study, the association between calcium intake and BMD appeared to be dependent upon VDR genotype. The findings of an association between dietary calcium intake and BMD only in the bb genotype group suggests that the VDR genotype may play a role in the absorption of dietary calcium. Studies that do not consider calcium intake may not detect associations between VDR genotype and BMD. In addition, the association between VDR alleles and BMD may become less evident in older subjects.

Adult↗
PubMed1997

Defining the role of molecular markers to monitor disease, intervention, and cartilage breakdown in osteoarthritis.

Osteoarthritis (OA) is associated with a loss of the normal balance between synthesis and degradation of the macromolecules that provide articular cartilage with its biomechanical and functional properties. The destruction of joint cartilage involves the degradation of matrix molecules which are released as fragments to joint fluid, blood, and urine, where they may be detected, for example, by immunoassay. It has been suggested that such molecular markers of cartilage matrix metabolism could be used as markers to determine diagnosis, prognosis, and severity, to predict response to therapy and monitor response to therapy, and to identify disease mechanisms on the molecular level. Since markers reflect ongoing dynamic changes in joints, they are perhaps most likely to serve as measures of prognosis and measures of response to treatment. Some markers may serve multiple functions. To function as adequate tests, they should meet a set of standards. It is only when markers have met such criteria that they will be accepted in the research and clinical community and will become widely used.

Biomarkers↗
PubMed1997

Osteoporosis clinical trials endpoints: candidate variables and clinimetric properties.

We reviewed evidence on endpoints used in osteoporosis clinical trials to assist in the development of a set of endpoints to be included in all trials. A MEDLINE search was conducted using the Cochrane Collaboration strategy for each endpoint. Additional published literature was obtained from content experts. A proposed list of endpoints was developed after consultation with experts in the field. Each endpoint was evaluated with respect to validity, reproducibility, redundancy, and feasibility. We classified the endpoints into 2 major categories: clinical health status outcomes and intermediate endpoints, and for each endpoint we present current evidence from the literature as pertains to defined methodologic criteria. Multiple endpoints have been used in osteoporosis clinical trials, and an agreement on a core set of measures needs to be evidence based with an emphasis on validity, reproducibility, and feasibility and to satisfy clinical credibility.

Biomarkers↗
PubMed1997

Radiographic hand osteoarthritis: incidence, patterns, and influence of pre-existing disease in a population based sample.

OBJECTIVE: Osteoarthritis (OA) is the most common type of arthritis; involvement of joints in the hand is highly prevalent, especially in the elderly. Few data are available on the incidence of hand OA in men and women or on the association between OA in one hand joint with incidence in others. METHODS: We studied the cumulative incidence of radiographic hand OA in a population based group of men and women, and evaluated whether baseline OA in one joint affected OA rates in other joints in the hand. Study subjects were 751 members of the Framingham Study cohort, who had a baseline right hand radiograph taken in 1967-1969 (mean age 55+/-5.58) and followup radiographs 24 years later. RESULTS: In those without OA at baseline, women had more incident disease than men in almost all hand joints, but the joints most frequently affected were the same in both sexes: the distal interphalangeal (DIP), followed by the base of the thumb, proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints. The MCP joint group was the only one in which the incidence in men was comparable to incidence in women. Prevalent OA in one or more joints in a row (e.g., MCP) markedly increased the risk of incident OA in other joints in the same row. Also, prevalent OA in one joint in a finger (a ray) increased the risk of incident OA in other joints in that ray. Prevalent OA in either DIP or PIP joints at baseline substantially increased the risk of incident OA in all other hand joints. Thumb base OA at baseline increased risk in MCP joints, and to a lesser extent, DIP and PIP joints. CONCLUSION: Cumulative incidence was generally higher in women than men, baseline OA in one joint in a row markedly increased the risk of developing OA in other joints in the same row, and baseline OA in a joint in a ray similarly increased risk in that ray. Interphalangeal joint OA at baseline appeared to increase subsequent OA in all hand joints, baseline OA in the thumb was not as strong a predictor. This descriptive information on incidence of radiographic hand OA should generate new hypotheses about why OA affects hands in particular patterns.

Age Distribution↗
PubMed1996

Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study.

BACKGROUND: Evidence suggests that pathophysiologic processes in bone are important determinants of outcome in osteoarthritis of the knee. Low intake and low serum levels of vitamin D may compromise favorable responses of bone to osteoarthritis, predisposing patients to progression. OBJECTIVE: To determine whether dietary intake and serum levels of vitamin D would predict the incidence and progression of osteoarthritis of the knee in participants of the Framingham Study. DESIGN: Prospective observational study. SETTING: The Framingham Study. PARTICIPANTS: Participants in the Framingham Heart Study who had knee radiography at examinations 18 (done between 1983 and 1985) and 22 (done between 1992 and 1993) and received interim assessments of vitamin D intake and serum levels. MEASUREMENTS: Intake of vitamin D and serum levels of 25-hydroxyvitamin D, calculated on the basis of dietary habits and supplement use as reported on a questionnaire, were evaluated at examination 20 (1988 to 1989). Knee radiographs were given scores for global severity of osteoarthritis, using a modification of the scale of Kellgren and Lawrence (range, 0 to 4), and for the presence of osteophytes and joint-space narrowing (range, 0 to 3). Covariates measured at examinations 18 and 20 were age, sex, body mass index, weight change, injury, physical activity, health status, bone mineral density, and energy intake. RESULTS: 556 participants (mean age at baseline +/- SD, 70.3 +/- 4.5 years) had complete assessments. Incident osteoarthritis occurred in 75 knees; progressive osteoarthritis occurred in 62 knees. Serum levels of vitamin D were modestly correlated with vitamin D intake (r = 0.24). Risk for progression increased threefold in participants in the middle and lower tertiles for both vitamin D intake (odds ratio for the lower compared with the upper tertile, 4.0 [95% Cl, 1.4 to 11.6]) and serum levels of vitamin D (odds ratio for the lower compared with the upper tertile, 2.9[Cl, 1.0 to 8.2]). Low serum levels of vitamin D also predicted loss of cartilage, as assessed by loss of joint space (odds ratio, 2.3 [Cl, 0.9 to 5.5]) and osteophyte growth (odds ratio, 3.1 [Cl, 1.3 to 7.5]). Incident osteoarthritis of the knee occurring after baseline was not consistently related to either intake or serum levels of vitamin D. CONCLUSIONS: Low intake and low serum levels of vitamin D each appear to be associated with an increased risk for progression of osteoarthritis of the knee.

Cartilage, Articular↗
PubMed1996

Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis?

OBJECTIVE: Cumulative damage to tissues, mediated by reactive oxygen species, has been implicated as a pathway that leads to many of the degenerative changes associated with aging. We hypothesized that increased intake of antioxidant micronutrients might be associated with decreased rates of osteoarthritis (OA) in the knees, a common age-related disorder. METHODS: Participants in the Framingham Osteoarthritis Cohort Study underwent knee evaluations by radiography at examinations 18 (1983-1985) and 22 (1992-1993). Usual dietary intake was assessed using the Food Frequency Questionnaire, administered at examination 20 (1988-1989). Knees without OA at baseline (Kellgren and Lawrence [K&L] grade < or = 1) were classified as having incident OA if they had a K&L grade > or = 2 at followup. Knees with OA at baseline were classified as having progressive OA if their score increased by > or = 1 at followup. Knees were also classified as having cartilage loss or osteophyte growth if their maximal joint space narrowing or osteophyte growth score increased by > or = 1 (range 0-3). The association of vitamin C, beta carotene, and vitamin E intake, ranked in sex-specific tertiles, with incidence and progression of OA was compared with that of a panel of nonantioxidant vitamins, Bl, B6, niacin, and folate, using logistic regression and generalized estimation equations to adjust for correlation between fellow knees. The lowest tertile for each dietary exposure was used as the referent category. Odds ratios (OR) were adjusted for age, sex, body mass index, weight change, knee injury, physical activity, energy intake, and health status. RESULTS: Six hundred forty participants received complete assessments. Incident and progressive OA occurred in 81 and 68 knees, respectively. We found no significant association of incident OA with any nutrient. A 3-fold reduction in risk of OA progression was found for both the middle tertile (adjusted OR = 0.3, 95% confidence interval [95% CI] 0.1-0.8) and highest tertile (adjusted OR = 0.3, 95% CI 0.1-0.6) of vitamin C intake. This related predominantly to a reduced risk of cartilage loss (adjusted OR = 0.3, 95% CI 0.1-0.8). Those with high vitamin C intake also had a reduced risk of developing knee pain (adjusted OR = 0.3, 95% CI 0.1-0.8). A reduction in risk of OA progression was seen for beta carotene (adjusted OR = 0.4, 95% CI 0.2-0.9) and vitamin E intake (adjusted OR = 0.7, 95% CI 0.3-1.6), but was less consistent. No significant associations were observed for the nonantioxidant nutrients. CONCLUSION: High intake of antioxidant micronutrients, especially vitamin C, may reduce the risk of cartilage loss and disease progression in people with OA. We found no effect of antioxidant nutrients on incident OA. These preliminary findings warrant confirmation.

Aged↗
PubMed1996

A prospective long-term study of fibromyalgia syndrome.

OBJECTIVE: To ascertain the long-term natural history of fibromyalgia syndrome (FMS). METHODS: Patients with a history of FMS, seen in an academic rheumatology referral practice, were originally surveyed soon after onset of symptoms, and then were reinterviewed 10 years later in a prospective followup cohort study. A validated telephone survey was administered that inquired into current symptoms, medical care and treatments used, and work disability. The results were compared with the prior surveys. RESULTS: Of the original 39 patients, there were 4 deaths. Of the remaining 35 patients, 29 (83%) were reinterviewed. Mean age at current survey was 55 years, and mean duration of symptoms was 15.8 years. All patients had persistence of some fibromyalgia symptoms, although almost half (48%) had not seen a doctor for them in the last year. Moderate to severe pain or stiffness was reported in 55% of patients; moderate to a lot of sleep difficulty was noted in 48%; and moderate to extreme fatigue was noted in 59%. These symptoms showed little change from earlier surveys. In 79% of patients, medications were still being taken to control FMS symptoms. Despite continuing symptoms, 66% of patients reported that FMS symptoms were a little or a lot better than when first diagnosed. Fifty-five percent of patients said they felt well or very well in terms of FMS symptoms, and only 7% felt they were doing poorly. With the exception of sleep trouble, which was persistent, baseline survey symptoms correlated poorly with symptoms at the 10-year followup. CONCLUSION: FMS symptoms last, on average, at least 15 years after illness onset. However, most patients experience some improvement in symptoms after FMS onset.

Adult↗