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F Wolfe

Publications and source records attributed to F Wolfe.

At least 73 records · Page 4Linked to original sources
PubMed1998

The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis.

OBJECTIVE: Although total joint arthroplasty (TJA) is a common procedure and an important outcome in rheumatoid arthritis (RA), little is known about its prevalence, failure rate, or predictors over the course of the illness. The current study evaluated these factors in 1,600 consecutive RA patients seen during a period of observation that extended 23 years. METHODS: Beginning in 1974, data from 34,040 RA patient visits were entered prospectively into a computer databank. Data consisted of laboratory, radiographic, physical examination, and self-report questionnaires. At each assessment, we also noted a complete surgical history. Patients were also followed up by questionnaires that were mailed at 6-month intervals. RESULTS: Kaplan-Meier life-table estimates indicated that 25% of RA patients will undergo total joint arthroplasty (TJA) within 21.8 years of disease onset. For patients with 1 TJA, 25% had a TJA in a different joint within 0.92 years and 50% within 7.0 years. Ten years after TJA, approximately 6% of implanted knees and 4% of implanted hips had been replaced with a second TJA, and 12% and 13% of the joints had either a second TJA or a TJA-related operation, respectively. In Cox regressions, a large series of clinical and laboratory variables, which primarily reflected disease activity, predicted TJA. Smoking, either past or present, had a protective effect. Patients with highly abnormal values on the Health Assessment Questionnaire Disability Scale, global severity, and erythrocyte sedimentation rate had a 3-6 times increased risk of TJA. CONCLUSION: TJA, a marker of joint failure and of RA outcome, is predicted by self-report assessments of severity and function, and by a series of laboratory, radiographic, and clinical variables. Prediction improves with the extent of observation, and 2-year observations approach full-study observations in their accuracy. Most TJAs survive for a long time in RA.

Arthritis, Rheumatoid↗
PubMed1998

Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression.

OBJECTIVE: To describe the longitudinal radiographic course of rheumatoid arthritis (RA), and to identify and quantitate predictors of radiographic progression. METHODS: This prospective, longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease (mean 0.77 years) and were followed up for up to 19 years. Participants underwent a total of 6,278 clinical assessments (mean 24.5) and 934 paired radiographs (mean 3.1, range 2-6). Clinical assessments at every visit included determination of the erythrocyte sedimentation rate (ESR), grip strength, pain scores, tender joint counts, and anxiety and depression measurements. Regression analyses utilized time-integrated predictors. RESULTS: Overall, radiographic progression rates, as measured by the summary Sharp scores, appeared constant over the course of RA. The strongest correlate of progression was the time-integrated ESR (rho=0.53). This association grew stronger with time. At 0-5 years, 5-10 years, 10-15 years, and 15-20 years, correlations were 0.40, 0.50, 0.65, and 0.74, respectively, and for the period 10-20 years, the correlation was 0.67. In multivariate models, the mean ESR, mean grip strength, rheumatoid factor positivity, and tender joint count were independent predictors of radiographic progression. CONCLUSION: Radiographic damage occurs at a constant rate in RA, and is not greater early in RA or reduced later in the course of the illness. Acute-phase reactants are, by far, the strongest determinants of progression.

Adult↗
PubMed1998

A comparison of IgM rheumatoid factor by nephelometry and latex methods: clinical and laboratory significance.

OBJECTIVES: To study the comparative performance characteristics of nephelometric and IgM latex rheumatoid factor (RF) with regard to diagnosis, to determine the level of test result that most accurately classifies patients as having rheumatoid arthritis (RA) versus noninflammatory rheumatic disorders, to develop mathematic and graphic conversion tools, and to determine the usefulness of serial nephelometric RF factors test in assessing change in clinical status. METHODS: Sera and clinical measurements were obtained from 576 rheumatic disease patients during routine clinic visits and were analyzed by latex and nephelometric methods. RESULTS: Nephelometric and latex methods were highly correlated (0.872) and generally equivalent in their ability to discriminate between RA and noninflammatory conditions. Serial measures of RF were correlated with changes in clinical activity, but were much less effective in this respect than erythrocyte sedimentation rate or C-reactive protein. CONCLUSION: Both tests yield equivalent results. Mathematic and graphic models will allow conversion between tests so that clinicians can use either or both methods effectively. RF is modestly correlated with changes in clinical activity and therefore is not a useful measure to follow clinical improvement or worsening.

Arthritis, Rheumatoid↗
PubMed1998

A survey of United States rheumatologists concerning effectiveness of disease-modifying antirheumatic drugs and prednisone in the treatment of rheumatoid arthritis.

OBJECTIVE: To collect the ratings of American rheumatologists regarding relative short-term and long-term effectiveness of disease-modifying antirheumatic drug (DMARD) therapy in the treatment of rheumatoid arthritis and to compare these data with results of a meta-analysis of randomized, controlled clinical trials (RCTs) of these drugs. METHODS: A survey was mailed to 3,200 United States rheumatologists who were members of the American College of Rheumatology during the summer of 1996. The survey was completed by 645 rheumatologists. RESULTS: Methotrexate (MTX) was rated as substantially more effective than any other DMARD after both 1 year and 4 years of therapy. At 1 year, more than 90% of rheumatologists rated MTX as "good or excellent," compared with 35% giving a similar rating to intramuscular (IM) gold, the second-ranked DMARD. At 4 years, MTX was rated as "good or excellent" by 65%, compared with 53% for combinations, 30% for prednisone, and 11% for hydroxychloroquine, the second-ranked single DMARD. These ratings reflect results of long-term observational studies, but differ considerably from a meta-analysis of results of short-term RCTs, in which the efficacy of MTX, sulfasalazine, penicillamine, and IM gold were indistinguishable. CONCLUSION: The ratings of US rheumatologists regarding effectiveness of DMARD therapies are in agreement with observational data, but differ substantially from results of RCTs. These findings suggest that observational studies may yield useful and important information about treatment results, which are complementary to, but not available from, the RCT model. Regulatory agencies should consider long-term observational studies as a part of the evaluation of drugs.

Anti-Inflammatory Agents↗
PubMed1998

Psychosocial factors and the fibromyalgia syndrome.

Psychosocial distress and psychological abnormality occurs frequently in fibromyalgia patients. Patterns of decreased levels of education, and increased rates of divorce, obesity, and smoking have been noted in clinical and epidemiological studies. Links to physical and sexual abuse have been noted as well. Major depression as well as increased rates of depression, anxiety, and somatization are also commonly found in fibromyalgia.

Adolescent↗
PubMed1998

What use are fibromyalgia control points?

OBJECTIVE: To investigate the relationship between control points and symptom and distress severity in fibromyalgia (FM). METHODS: Eighty-four new patients with FM seen at an outpatient rheumatology center from December 1994 through August 1996 underwent tender point and dolorimetry examinations at 18 active and 4 control sites. All completed the assessment scales for fatigue, sleep disturbance, anxiety, depression, global severity, pain, and functional disability, and a composite measure of distress constructed from scores of sleep disturbance, fatigue, anxiety, depression, and global severity -- the Rheumatology Distress Index (RDI). RESULTS: Control point positivity was common in FM (63.1%) and was associated with somewhat more severe FM symptoms and general distress, yielding an increase in the RDI of 9.2 units or 0.55 standard deviation units. There was no evidence of particularly worse disease in patients with high counts of control tender points, and increasing numbers of tender points beyond the first positive control point were generally not associated with, or were only weakly associated with, increasing symptom severity. Many patients with positive control points had only mild levels of symptom severity. Finally, we found no clusters of patients with very severe symptoms associated with control points, or with dolorimetry scores, or with ratios of dolorimetry scores from different body regions of varying pain thresholds. CONCLUSION: Positive control points are a common feature (63%) in FM, and appear to be a marker for a generally low pain threshold rather than a disproportionate increase in severe symptoms or distress. Control point positivity should not be used to disqualify a diagnosis of FM. Control point measurements do not add much to FM diagnosis or assessment and, perhaps, should be abandoned. At the least, they should be designated "high threshold" points rather than control points. Dolorimetry is considerably less useful in FM assessment than the manual tender point examination.

Fibromyalgia↗
PubMed1998

The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients.

OBJECTIVE: Work disability is a common outcome of rheumatoid arthritis (RA). Yet there have been no longitudinal, longterm, prospective studies of work disability in this illness. This 18 year longitudinal study investigates the rate of work disability, its concomitants, and its predictors, using a large series of clinical, laboratory, and self-report measures. METHODS: In 1974, a computerized database was developed for the contemporaneous entry of all patient visits. Data included clinical, laboratory, and self-report information. Patients were also assessed by mailed questionnaires at 6 month intervals. In 1994, patients with RA were interviewed in detail about lifetime work status and work disability. RESULTS: Work disability was estimated to occur in 25% at 6.4 years and 50% at 20.9 years after disease onset, and most disability occurred late in the course of disease. Work disability was predicted by almost every demographic and clinical variable. Education level, body mass index (BMI), erythrocyte sedimentation rate, rheumatoid factor, pain, Health Assessment Questionnaire (HAQ) disability, and physical demands of the job were independently associated with disability. Over the course of their illness, the work disabled had a 35% reduction in family income, and had more abnormal scores for joint counts, grip strength, sedimentation rate, pain, global severity, HAQ disability, and anxiety and depression. Except for BMI, the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year. CONCLUSION: Work disability can be predicted by patient and work characteristics present at the first clinic visit, but it is persistent abnormalities of sedimentation rate, HAQ disability, and pain, which may be detected in longitudinal followup, that best predict work disability after work and demographic characteristics are accounted for.

Adult↗
PubMed1997

The prognosis of rheumatoid arthritis: assessment of disease activity and disease severity in the clinic.

The prognosis of rheumatoid arthritis is best described separately for mortality, work disability, costs, functional disability, total joint arthroplasty, radiographic abnormality, and psychosocial factors. The most important determinants of prognoses are the severity and persistence of disease activity. Methods for disease activity assessment have been developed for use in clinical trials, but these are often not suitable for use in clinical practice because of time constraints, costs, and special training required. However, clinicians can measure disease activity relatively simply according to joint counts, acute-phase reactants, and patient self-report tests. Nomograms, based on percentile ranking of disease activity variables, are simple tools that can be used in the clinic to estimate disease activity and change in clinical status.

Arthritis, Rheumatoid↗
PubMed1997

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury.

OBJECTIVE: To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS). METHODS: One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation; and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL). RESULTS: Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning. CONCLUSION: FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.

Adult↗
PubMed1997

A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia.

OBJECTIVE: To study, for the first time, service utilization and costs in fibromyalgia, a prevalent syndrome associated with high levels of pain, functional disability, and emotional distress. METHODS: Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospective study of fibromyalgia outcome. Patients were assessed every 6 months with validated, mailed questionnaires which included questions regarding fibromyalgia symptoms and severity, utilization of services, and work disability. RESULTS: Fibromyalgia patients averaged almost 10 outpatient medical visits per year, and when nontraditional treatments were considered, this number increased to approximately 1 visit per month. Patients were hospitalized at a rate of 1 hospitalization every 3 years. In each 6-month study period, patients used a mean of 2.7 fibromyalgia-related drugs. Costs increased over the course of the study. The mean yearly per-patient cost in 1996 dollars was $2,274. However, results were skewed by high utilizers, and many patients used few services and had limited costs. Total costs and utilization were independently associated with the number of self-reported comorbid or associated conditions, functional disability, and global disease severity. Compared with patients with other rheumatic disorders, those with fibromyalgia were more likely to have lifetime surgical interventions, including back or neck surgery, appendectomy, carpal tunnel surgery, gynecologic surgery, abdominal surgery, and tonsillectomy, and were more likely than other rheumatic disease patients to report comorbid or associated conditions. Almost 50% of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms. CONCLUSION: The average yearly cost for service utilization among fibromyalgia patients is $2,274. Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services. They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions, and symptom reporting is linked to service utilization and, to a lesser extent, functional disability and global disease severity.

Adult↗
PubMed1997

Health status and disease severity in fibromyalgia: results of a six-center longitudinal study.

OBJECTIVE: To determine the intermediate and long-term outcomes of fibromyalgia in patients seen in rheumatology centers in which there is special interest in the syndrome. METHODS: We conducted a longitudinal outcome study by mailed comprehensive Health Assessment Questionnaire administered every 6 months to 538 patients, from 6 rheumatology centers, whose median duration of disease at first assessment was 7.8 years. The final assessment took place after 7 years. In addition, there was study followup on 85 patients who had attended the Wichita center for > 10 years. RESULTS: Although functional disability worsened slightly and health satisfaction improved slightly, measures of pain, global severity, fatigue, sleep disturbance, anxiety, depression, and health status were markedly abnormal at study initiation and were essentially unchanged over the study period. Correlations between first and last assessment values were as high as r = 0.82. For some variables, abnormalities were 3 times greater at one center compared with another. CONCLUSION: Patients with established fibromyalgia, seen in rheumatology centers in which there a special interest in the disease and followed up for as long as 7 years, have markedly abnormal scores for pain, functional disability, fatigue, sleep disturbance, and psychological status, and these values do not change substantially over time. Half the patients are dissatisfied with their health, and 59% rate their health as fair or poor. There are marked differences in disease severity among the various centers, but < 14% of the variance in outcomes can be explained by demographic or center factors. Values at the first assessment are predictive of final values.

Cohort Studies↗
PubMed1997

Measurement of the quality of life in rheumatic disorders using the EuroQol.

The EuroQol is a validated quality of life (QOL) scale that has been used in population and clinical studies, and has been reported in patients with rheumatoid arthritis (RA). It is short, simple to complete, and might be suitable for surveys of rheumatic disease patients. The properties of this instrument were investigated in a postal survey of 1372 rheumatic disease patients, including 537 with RA, 319 with osteoarthritis (OA) and 516 with fibromyalgia. In addition, simultaneous measurements of functional disability, pain, psychological status, global severity and demographic characteristics were made. EuroQol scores (0.57) were significantly lower than VAS health state scores (0.67) and arthritis-related global severity scores (0.62). QOL was similar in RA and OA, but lower in fibromyalgia, across all instruments. The distribution of EuroQol scores had many gaps and was not continuous. EuroQol did not reflect VAS QOL scores at EuroQol levels below 0.5, and the mean score difference between the instruments below that level was 0.43. Many patients with low EuroQol scores (including some with health states that were 'worse than death') had high VAS scores. These differences appear to have arisen because disability, pain and depression questions ask about mild or moderate problems, but not both, thereby forcing scale compression in the mid ranges. In addition, the 'severe' value is so extremely abnormal that few patients endorse it. Finally, penalty scores are applied to those with at least one maximally abnormal score. The scoring properties and distributional aspects of the EuroQol indicate substantial problems in its use in rheumatic disease patients.

Activities of Daily Living↗
PubMed1997

The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic.

OBJECTIVE: To investigate the relation between measures of pain threshold and symptoms of distress to determine if fibromyalgia is a discrete construct/ disorder in the clinic. METHODS: 627 patients seen at an outpatient rheumatology centre from 1993 to 1996 underwent tender point and dolorimetry examinations. All completed the assessment scales for fatigue, sleep disturbance, anxiety, depression, global severity, pain, functional disability, and a composite measure of distress constructed from scores of sleep disturbance, fatigue, anxiety, depression, and global severity-the rheumatology distress index (RDI). RESULTS: In regression analyses, the RDI was linearly related to the count of tender points (r2 = 0.30). Lesser associations were found between the RDI and dolorimetry measurements (r2 = 0.08). The RDI was more strongly correlated with the two measures of pain threshold than any of the individual fibromyalgia symptom variables. In partial correlation analyses, all of the information relating to symptom variables was contained in the tender point count, and dolorimetry was not independently related to symptoms. CONCLUSION: Tender points are linearly related to fibromyalgia variables and distress, and there is no discrete enhancement or perturbation of fibromyalgia or distress variables associated with very high levels of tender points. Although fibromyalgia is a recognisable clinical entity, there seems to be no rationale for treating fibromyalgia as a discrete disorder, and it would seem appropriate to consider the entire range of tenderness and distress in clinic patients as well as in research studies. The tender point count functions as a 'sedimentation rate' for distress, and is a better measure than the dolorimetry score.

Fibromyalgia↗
PubMed1997

Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population.

OBJECTIVE: To investigate the association of serum serotonin with fibromyalgia (FM), and to study the relationship of serotonin to clinical variables associated with FM. METHODS: Serum samples (n = 292) were obtained on subjects without pain, with regional pain, and with widespread pain during a population survey. The tender point examination was made according to American College of Rheumatology examination criteria by an examiner blind to the subjects' complaints. Serotonin was determined by high performance liquid chromatography coupled to an electrochemical detector. RESULTS: No associations between clinical variables and serotonin levels were found in the group as a whole. Subjects with FM had lower serotonin levels unadjusted (p = 0.019) and adjusted for age and sex (p = 0.059) than those without FM. Within the FM group, associations between serotonin and tender point count (r = 0.563) and depression (r = 0.549) were noted, but the direction of association was opposite to previous reports and expectations. CONCLUSION: Serum serotonin levels are significantly lower in persons with FM compared to those without FM, but the range of values is wide. Difficult to explain correlations with reversed directions are noted for tender point count, dolorimetry, depression, and anxiety among those with FM. Serotonin is not correlated with any clinical variables in the general population, and separate pain groups cannot be distinguished.

Analysis of Variance↗
PubMed1997

Practical issues in psychosocial measures.

Psychosocial variables were recognized as key clinical determinants and outcomes in rheumatic disease. Clinical interventions can produce clinically important improvement in psychological status, and clinicians regularly employ anxiolytic and antidepressant drugs. Yet assessment of psychological status is rarely undertaken in routine clinical practice. In part, this failure stems from the fact that most formal psychological instruments are too complicated, take too much time to administer, cannot be administered in real time, and are difficult to interpret. A practical way to assess psychological status in the clinic is to use short depression instruments such as the Center for Epidemiological Studies Depression scale (CES-D) or the Arthritis Impact Measurement Scales (AIMS) anxiety and depression subscales. Another approach to psychological assessment is to measure surrogate variables, that is, variables that are not primarily psychological and have practical use in rheumatic disease care. The Clinical Health Assessment Questionnaire (CLINHAQ) assesses such surrogate variables via visual analog scales for pain, fatigue, and sleep disturbance, the helplessness subscale of the Rheumatology Attitudes index, a self-report measure of satisfaction with health, and the AIMS anxiety and depression scales. This instrument, which also contains the Health Assessment Questionnaire disability index, a pain diagram, and assessment of global severity, can be completed in 5 minutes by almost all clinic patients.

Clinical Trials as Topic↗
PubMed1997

Work and disability status of persons with fibromyalgia.

OBJECTIVE: To determine the prevalence and determinants of self-reported work disability in persons with fibromyalgia (FM). METHODS: A longitudinal, multicenter survey of 1604 patients with FM from 6 centers with diverse socioeconomic characteristics was begun in 1988. Assessments were by self-report questionnaire and telephone contact, and included work and disability events that occurred before and after 1988. Comparative analyses were performed on the entire data set and, separately, on the Wichita data set. RESULTS: More than 16% of patients reported receiving US Social Security disability (SSD) payments (highest center rate 35.7%; lowest center rate 6.3%) compared to 2.2% of the US population (US Social Security Administration data) and 28.9% of patients with rheumatoid arthritis seen at the Wichita outpatient rheumatology clinic. Overall, 26.5% reported receiving at least one form of disability payment when SSD and other sources of disability payments were considered. In Wichita, less than 25% of SSD awards were made specifically for FM, but after 1988 that figure increased to 46.4%. Work disability was greatest at the San Antonio and Los Angeles centers. Multivariate predictors (correlates) included pain, Health Assessment Questionnaire disability, and unmarried status. In addition, more than 70% of patients reporting being disabled did receive disability payments. On the other hand, 64% reported being able to work all or most days, and more than 70% were employed or were homemakers. CONCLUSION: Although most patients (64%) report being able to work, we found high rates of self-reported work disability awards among persons with FM followed in 6 rheumatology centers. But we also found great variability among centers as to awards and as to self-reported work ability. Center differences in work disability might reflect clinic referral patterns, physician beliefs, or socioeconomic status.

Aged↗
PubMed1997

Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis.

OBJECTIVE: To determine the comparative usefulness of the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the assessment of rheumatoid arthritis (RA) activity and to provide tables and nomograms of normative data in RA allowing the linking and interchange of test values. METHODS: We studied 774 patients with RA seen in the clinic by obtaining complete rheumatologic examinations and laboratory studies. Clinical variables included visual analog scale pain and global severity, joint count, functional disability, depression, and a composite measure of disease activity. In addition, we measured ESR and hemoglobin, and rheumatoid factor (RF), CRP, IgG, IgA, IgM, haptoglobin, alpha 1-antitrypsin, albumin, pre-albumin, and C4 by nephelometry. RESULTS: Median values for CRP were 0.82 mg/dl and ESR 26 mm/h. The average correlation with 7 clinical variables was 0.248 for ESR compared to 0.259 for CRP. But partial correlation analysis showed that a substantial portion of the correlation with ESR is explained by the effect of immunoglobulins, RF, and hemoglobin rather than the acute phase response. Twenty-eight percent of results were discordant between ESR and CRP, and this discordance was explained by the above factors. When discordance occurred, CRP was a better measure of disease activity than ESR. CONCLUSION: Simple comparisons between ESR and CRP suggest that both tests are similar, but partial correlation analysis indicates that part of the correlation between ESR and clinical variables comes from non-acute phase factors. These factors, in turn, are responsible for most of the discordance between ESR and CRP results. Thus, CRP appears to be the better test regarding measurement of the acute phase. Because ESR is sensitive to immunoglobulins and RF, it may measure general severity better than CRP, even though it is a poorer measure of inflammation. This perhaps accounts for the relative equivalence of the tests. The combination of ESR and CRP yields useful information that is often not apparent when only a single test is used.

Aged↗