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Biomedical subjects

F Wolfe

Publications and source records attributed to F Wolfe.

At least 91 records · Page 5Linked to original sources
PubMed1997

The C-reactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip.

OBJECTIVE: To investigate the association of C-reactive protein (CRP) with symptoms of clinical disease and demographic factors in osteoarthritis (OA). In addition, to compare CRP with erythrocyte sedimentation rate (ESR) in their ability to associate with osteoarthritic symptoms and features. METHODS: A total of 655 consecutive clinic patients with OA of the knee or hip underwent a rheumatic disease examination, completed a clinical health assessment questionnaire (CLINHAQ), and had laboratory tests performed, including hemoglobin, CRP, and ESR. RESULTS: The median value of CRP was 5.9 micrograms/ml. CRP was significantly associated with functional disability, joint tenderness, pain, fatigue, global severity, and depression. In addition, correlations were noted for body mass index (BMI) and sex. ESR, by contrast, was unassociated with clinical signs or symptoms except for a weak association with functional disability. The best explanatory multiple regression model for CRP in OA includes BMI, functional disability, and joint tenderness count (R-squared 0.159). CONCLUSION: CRP is elevated in OA compared to healthy individuals, and is correlated with rheumatic disease signs and symptoms, including HAQ disability, joint count, and pain. The associations, not seen with ESR, appear to be real, but are not strong. An inflammatory component associated with OA can be detected in the serum.

Blood Sedimentation↗
PubMed1997

Soul-deep blues.

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Bipolar Disorder↗
PubMed1996

Back pain in osteoarthritis of the knee.

OBJECTIVE: To compare patients with knee osteoarthritis (OA) who have and do not have back pain, and evaluate the prevalence, characteristics, and consequences of back pain among knee OA patients. METHODS: During a 3-year period, consecutive patients attending an outpatient rheumatology clinic were evaluated for the presence of back pain, and 368 were found to have OA of the knee. Clinical status was evaluated by the Clinical Health Assessment Questionnaire, radiographs, and joint examinations. RESULTS: Back pain was present in 54.6% of patients with OA of the knee. Almost every clinical status measure was worse among those reporting back pain, including Health Assessment Questionnaire (HAQ) disability, pain, global severity, fatigue, and psychological status. Back pain was more common in women and the obese, but was not associated with age, marital status, formal education, smoking history, or knee radiographic scores. In multivariate analyses the strongest correlates of back pain in knee OA patients were anxiety, night pain, HAQ disability, and global severity. CONCLUSION: Back pain is prevalent among OA clinic patients, more common than in rheumatoid arthritis or population studies, is linked to body mass index, and is associated with clinically significant increases in pain and other measures of clinical distress.

Aged↗
PubMed1996

Fibromyalgia and work disability: Is Fibromyalgia a disabling disorder?

Fibromyalgia appears to be an increasingly important source of disability claims and payments. Twenty-five percent of patients seen in rheumatology clinics have received disability payments. Yet fibromyalgia is a clinical rather than a legal construct, and there remain very important limitations regarding the reliability and validity of diagnosis and severity assessments outside of the clinic and in the medicolegal setting. Even so, preparation of disability assessments that cover key requirements can provide substantial assistance to disability adjudicators.

Disability Evaluation↗
PubMed1996

On the difficulties of disability and its determination.

The World Health Organization (WHO) model for the cascade of disease to impairment to disability to handicap does not adequately model pain and psychological dysfunction. The work disability of the legal system comprises WHO disability and handicap. But the physician usually cannot determine handicap. The process by which work disability is determined, imposing a judgment role on the physician, compromises the physician-patient relationship and the physician's primary responsibility: enablement of the patient. Physicians should report patient data, but ordinarily should not judge work disability.

Confidentiality↗
PubMed1996

Does exposure to immunosuppressive therapy increase the 10 year malignancy and mortality risks in rheumatoid arthritis? A matched cohort study.

Rheumatoid arthritis (RA) is associated with increased mortality and an increased risk of neoplasms of the immune system (NIM). To establish whether immunosuppressive therapy alters these risks, a matched cohort study was conducted. The exposed cohort were 259 RA patients, resident in the UK, who first received immunosuppressive drugs (mainly azathioprine, cyclophosphamide and chlorambucil) between 1979 and 1982. The unexposed cohort were 259 patients matched for age, sex and disease, resident in the USA, who had never received immunosuppressives. Both cohorts had no prior reported malignancies and were followed for 10 yr. There was a small increase in mortality in the exposed compared to the unexposed cohort. Most of the excess deaths were due to malignancy. The relative risk (RR) of developing malignancy [1.5 (95% CI 0.9-2.3)] was lower than the RR of dying from malignancy [4.2 (95% CI 1.7-10.0)]. The RR of developing a NIM in the immunosuppressive-exposed group was 7.0 (95% CI 0.9-56.5). These results may be explained in part by differences in cancer registration and death rates between the UK and the USA. Nevertheless, the results suggest that exposure to immunosuppressive therapy increases the 10 yr malignancy risk in RA, but not mortality from other causes.

Adult↗
PubMed1996

Tenidap in patients with rheumatoid arthritis. A 4-week, placebo-controlled study.

The present double-blind, placebo-controlled study was conducted to compare the safety and efficacy of tenidap in patients with rheumatoid arthritis (RA). Patients with flare of active RA following NSAID withdrawal were randomized to receive either placebo (n = 67) or tenidap (n = 131; 40-200 mg/day). The mean changes from baseline in efficacy and biochemical variables were compared between treatment groups at endpoint (4 weeks). The improvements in four of the five primary efficacy variables were significantly greater in the tenidap group compared with the placebo group (p < 0.01). Tenidap was also associated with an 18% reduction in erythrocyte sedimentation rate (ESR) and a marked, 51%, reduction in serum C-reactive protein (CRP) level, both of which were significantly greater than the changes in the placebo group (p < 0.05). The percentage of patients who discontinued because of side effects was the same in both groups (3%). In conclusion, tenidap 40-200 mg/day was effective and well tolerated in the treatment of patients with RA for 4 weeks.

Administration, Oral↗
PubMed1996

The natural history of rheumatoid arthritis.

The natural history of rheumatoid arthritis (RA) is best defined by a combination of disease specific measures such as radiographs and remission rates, and patient specific measures such as functional and work disability, total joint replacement, adverse drug reactions, social disruption and premature mortality. Prognosis depends largely on how RA is defined, since clinical RA has a worse and epidemiologic RA a better prognosis. Seronegative polyarthritis confounds the assessment of RA since it has a better prognosis for remission and longterm outcome. RA is a progressive disease in the clinic, particularly in patients with longterm followup. Ongoing cohort studies of recent onset RA may aid in our understanding of RA prognosis, but may still beg the question, what is RA?

Arthritis, Rheumatoid↗
PubMed1996

The prevalence and meaning of fatigue in rheumatic disease.

OBJECTIVE: To determine the prevalence of fatigue in rheumatic disease; to characterize the strength of associations between demographic and clinical features and fatigue; to identify predictors of fatigue, and to determine the consequence of clinically significant fatigue. METHODS: 1488 consecutive patients with rheumatic disease were assessed with the Clinical Health Assessment Questionnaire, a health status instrument with scales for fatigue, pain, global severity, sleep disturbance, gastrointestinal problems, anxiety, depression, health status, health satisfaction, and work ability. All patients underwent rheumatic disease examinations and laboratory testing. RESULTS: Fatigue measured by visual analog scale (VAS) was present in 88-98% of patients, but clinically important levels of fatigue (> or = 2.0 on VAS) were present in more than 41% of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) and 76% of those with fibromyalgia (FM). Fatigue was related to almost all demographic and clinical variables, but in multivariate analyses the strongest independent predictors of fatigue were pain, sleep disturbance, depression, tender point count and Health Assessment Questionnaire (HAQ) disability. About 90% of the R2 of the model (all patients = 0.51, RA = 0.49, OA = 0.45, FM = 0.41) was explained by pain, sleep disturbance, and depression. In RA assessed by erythrocyte sedimentation rate, joint count and grip strength, no association of the inflammatory process with fatigue could be found in the multivariate analyses. In measuring health status, fatigue was strongly associated with work dysfunction and general measures of health (VAS of global severity, health status, and health satisfaction). CONCLUSION: Fatigue is common across all rheumatic diseases, associates with all measures of distress, and is a predictor of work dysfunction and overall health status. The correlates of fatigue are generally similar across RA, OA and FM. Fatigue assessment adds much to understanding and management of patients and diseases.

Adolescent↗
PubMed1996

The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity.

OBJECTIVE: To determine the prevalence of muscular or myofascial temporomandibular disorders (TMD) in fibromyalgia (FM) and the prevalence of FM in TMD; and to determine which characteristics best distinguish the 2 disorders. METHODS: 39 consecutive patients with TMD seen in a TMD clinic and 60 patients with FM were examined according to Research Diagnostic Criteria (RDC) for TMD and the American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. All patients completed the questionnaires of the RDC and a health status instrument that assessed pain, function, sleep disturbance, fatigue, and psychological status (CLINHAQ). RESULTS: A small proportion of patients with TMD (18.4%) also had FM, but most of those with FM (75.0%) satisfied criteria for muscular (myofascial) TMD. Patients with FM had lower pain thresholds and more severe manifestations of all disease measures (e.g., pain, fatigue, sleep, etc.) compared to those with TMD. As might be predicted, they also had more painful body regions. Patients with FM also differed significantly from those with TMD in self-reported work ability and health assessment. The features that best differentiate FM from TMD are functional disability, reports of work difficulty, and general dissatisfaction with health. CONCLUSION: TMD is a local disorder and FM a generalized disorder, and there is less evidence of distress in those with TMD. TMD is a separate disorder from FM, but many patients with FM have TMD symptoms.

Adult↗
PubMed1996

Protective attire.

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Dental Hygienists↗
PubMed1995

The prevalence and characteristics of fibromyalgia in the general population.

OBJECTIVE: To determine the prevalence and characteristics of fibromyalgia in the general population. METHODS: A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. RESULTS: The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (> 7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. CONCLUSION: Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia--pain threshold and symptoms--are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.

Adult↗
PubMed1995

The epidemiology of drug treatment failure in rheumatoid arthritis.

The length of time that patients remain on anti-rheumatic therapy is an important measure of the effectiveness of that therapy since length of time on therapy is a composite measure that accounts for sustained, positive therapeutic benefit as well as negative therapeutic benefit (e.g. adverse reactions, unacceptable costs and loss of efficacy), and accounts for noise (non-compliance, psychological factors, misunderstanding, etc.). Effectiveness is a measure of how well a drug does work, while efficacy, the measure used in randomized controlled trials, means that a drug can work; however, efficacy may or may not translate to usefulness in the clinic. To understand drug effectiveness we reviewed studies of 5809 patients receiving various SMARDs. The average median time on drug ranged from 1.10 to 2.27 years, excluding methotrexate, with shortest survival times falling to sulfasalazine (1.10) and auranofin (1.16), intermediate times to hydroxychloroquine (1.59), penicillamine (1.42), IM gold (1.40), and the longest time to azathioprine (2.27). Overall, excluding methotrexate, the average median survival time was 1.41 for 3998 patients. Median time on drug was 3.3 times greater for all other drugs combined, averaging 4.61 years. Expressed in terms of '5-year survival,' an average of 55.7% of patients remained on methotrexate 5 years after it was started. Better results noted here for methotrexate stand in contradistinction to short-term randomized controlled trials which find most SMARDs to be equal in efficacy. Other factors that may influence drug survival time include age, age, education level, psychological status, presence of fibromyalgia, rank order of SMARD administration, disease severity or corticosteroid administration. Studies can provide more information if they also measure clinical variables as well as time on drug, providing area-under-the-curve measurements.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

Chronic Disease↗