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Biomedical subjects

F Wolfe

Publications and source records attributed to F Wolfe.

At least 181 records · Page 10Linked to original sources
PubMed1987

Disability in rheumatoid arthritis: comparison of prognostic factors across three populations.

We previously identified variables that predict functional disability in rheumatoid arthritis (RA). Because of potential instabilities in the statistical model, we sought to determine whether these predictors were consistent across populations: 2,448 consecutive patients with (RA) were followed prospectively at ARAMIS centers in Phoenix, AZ, Wichita, KS, and Saskatoon, SK. Average followup was 1.7 years in Phoenix, 3.4 years in Wichita, and 12 years in Saskatoon. Twenty-four potentially predictive variables were analyzed by stepwise linear regression. Common predictors were age, sex, and duration of illness, suggesting that these variables are important predictors of disease regardless of the population being studied. In addition, the initial level of disability and radiographic variables are good predictors of disability. Elevated erythrocyte sedimentation rate and latex titers also were associated with future functional disability but do not have a linear relationship and predict less well.

Adolescent↗
PubMed1986

The clinical syndrome of fibrositis.

Fibrositis is a disorder of musculoskeletal pain and aching with at least a five to one female-to-male ratio. It is most commonly seen between the ages of 40 and 60, and has a prevalence in the clinic of 6 to 15 percent. Its most common mode of presentation involves generalized musculoskeletal pain and aching, but articular pain, axial skeletal pain, myalgias, and neurovascular complaints sometimes predominate. All patients have multiple areas of local tenderness called "tender points" that are easily identified during physical examination, and are diagnostic. Essential symptoms of fibrositis are disturbed sleep, morning stiffness, and fatigue. Additional rheumatic symptoms include subjective swelling, paresthesias, and numbness. Headaches and irritable bowel syndrome are common nonrheumatic complaints. Modest improvement follows treatment by tricyclic agents such as low-dose cyclobenzaprine and amitriptyline, by physical measures, and by reduction in stress. Remission occurs in 20 percent of patients, but is generally short-lived.

Adult↗
PubMed1986

Socioeconomic impact of fibrositis. A study of 81 patients with primary fibrositis.

Demographics and health service utilization were studied for 81 patients with fibrositis during 1985. Patients reported high levels of pain, mild disability, and moderate impairment of global health. Work disability was limited and only 6.3 percent described themselves as disabled. Employed patients were able to work full work weeks. Utilization of outpatient medical services was increased compared with that of control subjects and national averages during the study year, but was consistent with other rheumatic disorders such as osteoarthritis and low back pain. Medication usage was limited and seemed appropriate. Very high hospitalization rates were noted prior to diagnosis of fibrositis, both for musculoskeletal and non-musculoskeletal hospitalizations, but these rates dropped during the post-diagnosis study year.

Absenteeism↗
PubMed1986

Development of criteria for the diagnosis of fibrositis.

The essential symptoms of fibrositis--widespread aching and pain, disturbed sleep, morning stiffness, and fatigue--are common in both rheumatic and nonrheumatic patients. But the essential sign of fibrositis--widespread local tenderness over specific anatomic sites ("tender points")--is rare in any patients except those with fibrositis. Clinical criteria for the diagnosis of fibrositis rely heavily on a high tender point count in the presence of characteristic fibrositic symptoms. Multiple tender points are uncommon in normal subjects and in those with rheumatic and nonrheumatic disorders. The tender point count thus also serves to distinguish fibrositis from other musculoskeletal diseases.

Fibromyalgia↗
PubMed1986

A multicenter study of annual health service utilization and costs in rheumatoid arthritis.

The economic impact of chronic illness has important implications for medical practice and health policy. To determine the yearly costs of illness for those who have rheumatoid arthritis, a detailed, self-administered questionnaire was developed. The questionnaire was completed by 940 patients. Direct costs (recorded as charges) include the average annual expenditures by all patients and third party payers for: hospital care ($913), physician costs ($206), other health professional visits ($71), medications ($436), laboratory tests ($217), radiographs ($116), assistive devices ($24), and nontraditional therapies ($22). The total annual medical costs per patient were $2,533. In a multivariate analysis that controlled for age, sex, education, and disease duration, the outpatient costs, inpatient costs, and total costs were all positively related to the Health Assessment Questionnaire Disability Index (P f less than 0.01) and global health (P f less than 0.01), but were not associated with self-reported pain.

Arthritis, Rheumatoid↗
PubMed1986

A multicenter study of hospitalization in rheumatoid arthritis. Frequency, medical-surgical admissions, and charges.

During 1981, 123 of 816 patients (15.1%) with rheumatoid arthritis were hospitalized 160 times because of the disease. The mean length of hospitalization was 13.1 days, and the cost $7,845. Surgery accounted for 54.4% of admissions, but 69.2% of costs. The average cost for total joint surgery was $12,287. Most medical admissions (46.6%) were for the diagnosis or treatment of articular disease, but 42.5% were for treatment of side effects of therapy, and 11.0% for complications of RA. The most commonly performed surgical procedures included reconstructive surgery of the hand/wrist (n = 35) and foot (n = 22), followed by total knee replacement (n = 18).

Adult↗
PubMed1986

Impact of specific therapy upon rheumatoid arthritis.

We performed a prospective, parallel, descriptive study of 737 consecutive new uses for 11 drugs prescribed for patients with definite or classic rheumatoid arthritis. The patients were from 5 geographically dispersed sites. Researchers used validated outcome assessment instruments to measure endpoints of disability, pain, patient global assessment, medication costs, laboratory costs, and number of physician visits. Patients were studied by strict prospective protocol at 6-month intervals for 3 years. Controls included parallel results with other drugs, and before and after values for the individual patient. Beneficial effects were observed with the "disease-modifying" drugs: intramuscular gold, penicillamine, and methotrexate. Of these, gold had the most apparent effect. An average of 9 months of gold therapy resulted in highly significant reductions in disability (P less than 0.005), pain (P less than 0.001), and patient global assessment (P less than 0.005). However, patients receiving gold and methotrexate had nearly twice as many visits to physicians. In addition, drug costs increased strikingly with gold, and laboratory costs tripled. Relatively minor differences among nonsteroidal antiinflammatory agents were difficult to interpret. The outcome assessment techniques used in the study are sensitive measures, which confirm the results of experimental studies and extend observations to new outcomes, including cost and disability.

Anti-Inflammatory Agents↗
PubMed1986

Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.

The Minnesota Multiphasic Personality Inventory (MMPI) scales for Hypochondriasis, Depression, and Hysteria were studied in patients with rheumatoid arthritis (RA). The RA patients showed elevated scores on these scales, and these results are similar to those reported in each of 6 published studies. The elevated MMPI scale scores can be explained largely by 5 "disease-related" MMPI statements which met 2 criteria: they were among 11 of the 117 MMPI statements that two-thirds of rheumatologists predicted would be RA-associated; and RA patients and normal subjects differed significantly in their responses to these statements. The responses of RA patients and normal subjects to most other statements in the MMPI Hypochondriasis, Depression, and Hysteria scales were quite similar. In RA patients, responses to "disease-related" statements were correlated with results of measures of disease activity, which indicates that responses to these MMPI items reflect the severity, as well as the presence, of RA. These findings suggest that new criteria are needed for validation of the MMPI as a clinical tool for the recognition of hypochondriasis, depression, and hysteria in a patient who has RA.

Arthritis, Rheumatoid↗
PubMed1986

A controlled and blinded study of immunoreactant deposition at the dermal-epidermal junction of patients with primary fibrositis syndrome.

The prevalence of immunoreactant deposition at the dermal-epidermal junction (DEJ) in clinically normal, sun exposed skin was assessed by direct immunofluorescence (IF) in 36 patients with primary fibrositis syndrome (PFS) and 12 clinically healthy control subjects. A granular or homogeneous deposition of IgG was seen at the DEJ in 52.8% (19/36) of patients with PFS and in 16.7% (2/12) of controls. The difference in IgG deposition between patients with PFS and controls was statistically significant (p = 0.030). Patients with PFS and controls did not demonstrate significant IF staining for IgA, IgM, or C3. Albumin deposition at the DEJ appeared to parallel IgG deposition in patients with PFS and control subjects who were positive for this immunoglobulin. No relationship was noted between IgG deposition and demographic or clinical characteristics of these patients' disease. These data suggest that IgG and albumin deposition at the DEJ is frequent in PFS and that further study of this skin phenomenon is warranted.

Adult↗
PubMed1986

A multicenter study of hospitalization in rheumatoid arthritis: effect of health care system, severity, and regional difference.

During 1981, centers in Phoenix, Saskatoon, Stanford and Wichita monitored hospitalizations for 816 patients with rheumatoid arthritis. Admission rates varied 2-fold, and admissions for evaluation and treatment 10-fold across centers. Admissions were related primarily to disease severity, but in US centers, were reduced by a factor of 3 by prepaid health care. Length of stay was shortest in California (7.3 days), and longest in Saskatoon (16.3) where designated arthritis beds and government prepaid health care existed. Average charges for surgery were as high as $10,000 in Phoenix and as low as $4550 in Wichita. Charges and length of stay were unrelated to disease severity, but were responsive to health care delivery system, availability of facilities, and geographic and center variation.

Arizona↗
PubMed1986

Polyarticular pigmented villonodular synovitis in children: evidence for a genetic contribution.

Pigmented villonodular synovitis rarely occurs in multiple joints, and only once has been noted in siblings. We identified this disorder in 2 generations and found evidence for its presence in a third. It occurred in 2 sibling children at multiple sites. All affected individuals also had a rare autosomal dominant disorder, the multiple lentigines syndrome. Among the developmental abnormalities in this kindred were fibrous dysplasia, hypertelorism, pectus excavatum, high arched palate, and primary lymphedema. The etiology of pigmented villonodular synovitis is uncertain, and suggested causes include trauma, inflammation, neoplasia, and repeated hemorrhage. Our observations suggest genetic factors might also be important in the development of pigmented villonodular synovitis.

Adolescent↗
PubMed1985

Tender point count.

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Arthritis, Rheumatoid↗
PubMed1985

Fibrositis: symptom frequency and criteria for diagnosis. An evaluation of 291 rheumatic disease patients and 58 normal individuals.

We administered a 17-item symptom questionnaire modified from Campbell to 155 patients with fibrositis diagnosed at 3 centers, each using different criteria sets. A high degree of agreement in symptom proportions was found among centers. "Fibrositic" symptoms were also common in 136 patients with a variety of rheumatic diseases but not in the 58 normal individuals studied. Symptoms distinguished fibrositis patients from normals easily, but had insufficient specificity to distinguish them from other rheumatic disease patients. The tender point count better separated fibrositic and nonfibrositic patients than historical criteria. No combination of questions and tender point count performed better than the tender point count alone.

Back Pain↗
PubMed1985

The epidemiology of tender points: a prospective study of 1520 patients.

Tender point examinations were performed on 1520 consecutive patients with various rheumatic diseases. The mean tender point count was 2.1 (3.6 SD). Four or more tender points were found in 22.9%, 7 or more in 13.6%, 12 or more 4.3%, but 60.1% had no tender points. The tender point count increased gradually with age, reaching a maximum at age 70. Women had more tender points than men, Caucasians more than blacks or Hispanics. Isolated regional clusters of tender points occurred at the shoulder girdle in 7.8%, and the knees in 7.4%. Correlation between tender points and associated peripheral joint tenderness was poor.

Adult↗
PubMed1985

Remission in rheumatoid arthritis.

Four hundred and fifty-eight patients whose clinical data had been prospectively entered into a rheumatic disease databank were studied for remission utilizing remission criteria of the American Rheumatism Association and criteria modified for chart review. During the period of observation 86 of 458 or 18.8% had at least one remission by investigators' assessment on chart review and 18.1% by application of ARA criteria. Patients were followed for 1131 patient years and remission occupied 97 patient years. For patients achieving remission this period represented 34.5% of their followup duration. The median length of remission was 10 months. Nineteen (18.6) percent of gold treatment courses and 16.7% of penicillamine courses resulted in remission. Fourteen (13.6) percent of patients who never received remittive therapy also had remissions. The ARA Preliminary Criteria for Clinical Remission in Rheumatoid Arthritis displayed a sensitivity of 80.2% and a specificity of 96.2% in this population. In patients receiving remittive therapy, female sex, disease onset before age 60, and early development of erosions were associated with decreased proportion of remission.

Arthritis, Rheumatoid↗
PubMed1984

Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis.

Psychological status was investigated in 46 primary fibrositis (PF) patients, 32 with fibrositis occurring in association with rheumatoid arthritis (RAFIB) and in 76 control patients with rheumatoid arthritis. Groups were similar in tests of life stresses: Family Inventory of Life Events, Multidimensional Health Locus of Control, and self-motivation. Only 28% of PF and 25% of RAFIB had Minnesota Multiphasic Personality Inventory profiles classified as "normal" compared with 51-60% of controls. Both PF and RAFIB had elevated "neurotic" scales (hypochondriasis, depression, hysteria), but only PF patients had statistically significant elevations in the pychopathic deviancy, psychasthenia and paranoia scales. When the Arthritis Impact Measurement Scales were used, PF but not RAFIB patients demonstrated statistically significant elevations on the anxiety and depression scales.

Arthritis, Rheumatoid↗
PubMed1984

Fibrositis (Fibromyalgia) in rheumatoid arthritis.

We studied demographic socioeconomic and clinical characteristics of 38 patients with fibrositis (fibromyalgia) that occurred in association with rheumatoid arthritis (RAFIB) and 242 patients with rheumatoid arthritis (RA) alone. Fewer RAFIB patients were married (57.1%), and most (97.4%) were women. No statistically significant differences in income, medical expenditures or other demographic variables were identified. All measures of function, pain, disease activity and psychological status were more abnormal in RAFIB patients. The clinical characteristics that best differentiated RAFIB and RA patients were pain, depression, anxiety and erythrocyte sedimentation rate, in logistic and stepwise regression models. Evaluation of disease severity markers, including radiographic erosions and frequency of total joint replacement, suggested that disease severity in RAFIB and RA is similar.

Arthritis, Rheumatoid↗