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Biomedical subjects

J F Fries

Publications and source records attributed to J F Fries.

At least 127 records · Page 7Linked to original sources
PubMed1990

The American College of Rheumatology 1990 criteria for the classification of vasculitis. Patients and methods.

The American College of Rheumatology Subcommittee on Classification of Vasculitis of the Diagnostic and Therapeutic Criteria Committee developed classification criteria for 7 forms of vasculitis: polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, hypersensitivity vasculitis, Henoch-Schönlein purpura, giant cell (temporal) arteritis, and Takayasu arteritis. The data collection methods, quality control, and analytic procedures used to derive the classification rules are discussed herein.

Data Collection↗
PubMed1990

The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis.

Criteria for the classification of Wegener's granulomatosis (WG) were developed by comparing 85 patients who had this disease with 722 control patients with other forms of vasculitis. For the traditional format classification, 4 criteria were selected: abnormal urinary sediment (red cell casts or greater than 5 red blood cells per high power field), abnormal findings on chest radiograph (nodules, cavities, or fixed infiltrates), oral ulcers or nasal discharge, and granulomatous inflammation on biopsy. The presence of 2 or more of these 4 criteria was associated with a sensitivity of 88.2% and a specificity of 92.0%. A classification tree was also constructed with 5 criteria being selected. These criteria were the same as for the traditional format, but included hemoptysis. The classification tree was associated with a sensitivity of 87.1% and a specificity of 93.6%. We describe criteria which distinguish patients with WG from patients with other forms of vasculitis with a high level of sensitivity and specificity. This distinction is important because WG requires cyclophosphamide therapy, whereas many other forms of vasculitis can be treated with corticosteroids alone.

Biopsy↗
PubMed1990

The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis.

Criteria for the classification of hypersensitivity vasculitis were developed by comparing 93 patients who had this disease with 714 control patients with other forms of vasculitis. For the traditional format classification, 5 criteria were selected: age greater than 16 at disease onset, history of taking a medication at onset that may have been a precipitating factor, the presence of palpable purpura, the presence of maculopapular rash, and a biopsy demonstrating granulocytes around an arteriole or venule. The presence of 3 or more of these 5 criteria was associated with a sensitivity of 71.0% and a specificity of 83.9%. A classification tree was also constructed. The criteria appearing in the tree structure were the same as for the traditional format, except there were 2 pathology criteria: one required the presence of granulocytes in the wall of an arteriole or venule, and the other required the presence of eosinophils in the inflammatory exudate. The classification tree was associated with a sensitivity of 78.5% and a specificity of 78.7%.

Adolescent↗
PubMed1990

Aspirin, hydroxychloroquine, and hepatic enzyme abnormalities with methotrexate in rheumatoid arthritis.

Levels of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) in patients with rheumatoid arthritis from 5 centers involved in the Arthritis, Rheumatism, and Aging Medical Information System were correlated with the use of specific antirheumatic medications. Elevated levels of SGOT and SGPT were most frequent in patients taking salicylates and methotrexate (MTX) and least frequent in patients taking hydroxychloroquine. The combination of MTX and salicylates greatly increased the frequency of abnormal liver enzyme values. In contrast, the addition of hydroxychloroquine to a regimen of either MTX or aspirin essentially eliminated the SGOT and SGPT abnormalities. Results from all 5 centers were consistent and remained so after adjustment for age, sex, and disease duration. Knowledge of these important drug interactions may permit continuation of MTX therapy in patients in whom the drug might otherwise be discontinued.

Alanine Transaminase↗
PubMed1990

Running, osteoarthritis, and bone density: initial 2-year longitudinal study.

PURPOSE: The purpose of this study was to present the 2-year follow-up results examining associations of repetitive long-term physical impact (running) with osteoarthritis and osteoporosis in 34 members of a running club now aged 52 to 74 years and 34 matched control subjects. PATIENTS AND METHODS: Roentgenograms of the hands, lateral lumbar spine, and knees were assessed in pairs (1984 and 1986) without knowledge of running status. Computerized scans of the first lumbar vertebrae were obtained to quantify bone mineral. RESULTS: A decrease in bone density over the 2-year period was statistically significant for nearly all subjects, especially for runners who decreased their running habits. At the 2-year follow-up, runners maintained greater bone density. Progression of the roentgenographic scores for osteoarthritis demonstrated a statistically significant increase in almost all groups in this normative population over the 2-year period. Female runners had more spur formation in the weight-bearing knee roentgenograms than did control subjects. CONCLUSION: With the possible exception of spur formation in women, running did not appear to influence the development of radiologic osteoarthritis in the populations studied.

Aged↗
PubMed1990

Plain radiographs can be useful in estimating lumbar bone density.

On standard lateral roentgenograms of the lumbar spine, a decrease in bone density is said to be detectable only after a bone loss of about 40%. To evaluate this view, we compared findings on plain films with bone mineral content of L1 determined by quantitative computed tomography in 80 healthy subjects with a mean age of 60 years. The highest correlations with bone mineral content were found for the criteria "vertebral density versus soft tissue" (r = 0.5, p less than 0.0001), the "amount of trabeculations" (r = 0.49, p less than 0.0001), and for the "overall" estimate of osteopenia in the vertebra (r = 0.55, p less than 0.0001). Surprisingly, these three radiographic criteria proved to be most helpful in subjects with bone mineral content above 110 mg/cm3 (nonosteoporotic range). We conclude that lateral radiographs of the lumbar spine can provide a rough estimate of bone density in nonosteoporotic subjects which may be helpful in determining when further analysis with more precise methods is appropriate.

Bone Density↗
PubMed1990

Reevaluating the therapeutic approach to rheumatoid arthritis: the "sawtooth" strategy.

A new therapeutic philosophy for management of rheumatoid arthritis (RA) is required, since the traditional "pyramidal" strategy has failed to measurably improve longterm outcome. This paper attempts a conceptual overview of the problem and suggests an available solution. The increased repertoire of potentially disease-modifying drugs (DMARD) allows a new creativity, and toxicity with these agents has been less than expected. Yet, clinical improvement observed initially with these agents over the first 10 to 20 months of treatment is eventually lost and accelerated increase in disability follows. Given these observations, a "sawtooth" strategy is proposed, with 6 principles: early DMARD use, continual serial DMARD use, regular quantitative monitoring of disability to detect insidious progression, setting a disability ceiling for the individual patient, sequential change in DMARD treatment when the ceiling is reached, and deployment of analgesics and NSAID as adjunctive rather than "first line" therapy. This strategy offers the potential for long-term disease modification with reasonable toxicity levels.

Anti-Inflammatory Agents↗
PubMed1990

Safety issues related to DMARD therapy.

The old pyramidal approach to treatment of rheumatoid arthritis depended most fundamentally upon the beliefs that the most effective agents were also the most toxic, that toxic-therapeutic ratios of different drug categories were about the same, and that one should first use the least effective and least toxic drugs. Recent data, however, demonstrate the often severe toxicity of the nonsteroidal antiinflammatory drugs and the surprisingly good safety record of certain disease modifying antirheumatic drugs. New analyses tend, in general, to support less aggressive monitoring strategies. Some of the fundamental assumptions of the old pyramidal strategy are shown to have been inaccurate.

Anti-Inflammatory Agents↗
PubMed1990

Identification of patients at risk for gastropathy associated with NSAID use.

It is suggested that gastropathy associated with nonsteroidal antiinflammatory drugs (NSAID) is the most frequent and, in aggregate, the most severe drug side effect in the United States. This work is based on a consecutive series of 2,400 patients with rheumatoid arthritis (RA) followed prospectively for an average of 3.5 years by the American Rheumatism Association Medical Information System. We present a preliminary exploration of the magnitude of the problem, the population at risk and the patients within that population who are at particularly high risk. Patients on NSAID had a hazard ratio for gastrointestinal (GI) hospitalization that was 6.45 times that of patients not on NSAID. Characteristically, patients at high risk for GI hospitalization and GI death are older, have had previous upper abdominal pain, have previously stopped NSAID due to GI side effects and have previously used antacids or histamine2-receptor antagonists for GI side effects. These patients also frequently take corticosteroids. Patients attributing relatively minor symptoms to NSAID tend to be younger and female. Our preliminary analysis is univariate; since these variables are interdependent, firm conclusions regarding the relative importance of these risk factors require development of multivariate risk factor models. The syndrome of NSAID-associated gastropathy can be estimated to account for at least 2,600 deaths and 20,000 hospitalizations each year in patients with RA alone.

Adult↗
PubMed1989

Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use.

The thesis of this paper is that gastropathy associated with nonsteroidal antiinflammatory drugs (NSAIDs) is the most frequent and, in aggregate, the most severe drug side effect in the United States. This work is based on a consecutive series of 2400 patients with rheumatoid arthritis followed prospectively for an average of 3.5 yr by ARAMIS, the American Rheumatism Association Medical Information System. We present a preliminary exploration of the magnitude of the problem, the population at risk, and the patients within that population who are at particularly high risk. Patients on NSAIDs had a hazard ratio for gastrointestinal (GI) hospitalization that was 6.45 times that of patients not on NSAIDs. Characteristically, high-risk patients for GI hospitalization and GI death are older, have had previous upper abdominal pain, have previously stopped NSAIDs for GI side effects, and have previously used antacids or H2-receptor antagonists for GI side effects. They also are frequently on corticosteroids. In contrast, patients attributing relatively minor symptoms to the drug tend to be younger and more frequently female. Our preliminary analysis is univariate and, as these variables are interdependent, firm conclusions regarding the relative importance of these risk factors will require reevaluating our data base as it is expanded using multivariate analysis. The syndrome of NSAID-associated gastropathy can be estimated to account for at least 2600 deaths and 20,000 hospitalizations each year in patients with rheumatoid arthritis alone.

Adult↗
PubMed1989

Prevalence and expression of photosensitivity in systemic lupus erythematosus.

Photosensitivity was assessed in 125 patients with systemic lupus erythematosus (SLE) and in 281 patients with rheumatoid arthritis (RA) as controls. Photosensitivity was reported by 87/119 (73%) patients with SLE and in 62/269 (23%) patients with RA; involving the face in 72/122 (59%) patients with SLE, then arms, chest, and neck. Patients with SLE reported that sun exposure could exacerbate various systemic symptoms, 51/121 (42%) reported medical treatment for photosensitivity and 41/118 (35%) reported that photosensitivity had a significant impact on their lifestyle. There was no significant difference in disease severity, as judged by physician or laboratory results, between patients scoring high or low on the photosensitivity scale.

Adult↗
PubMed1989

Advances in management of rheumatic disease. 1965 to 1985.

Advances in management of the rheumatic diseases over the past 20 years have been substantial. Over this period, survival of patients with systemic lupus erythematosus improved dramatically. Previously fatal renal crisis in scleroderma became treatable. Survival in Wegener's granulomatosis improved from 7% after 2 years to over 90%. Gout became an easily and effectively managed disease. Polymyalgia rheumatica became readily recognized and dramatically treatable. Less quantifiably, the shift toward more aggressive use of an increasing repertoire of "disease-modifying" agents in rheumatoid arthritis gave hope of having altered the natural history of the disease. Replacement of destroyed joints dramatically reduced pain and improved function in appropriately selected individuals. An increasingly broad mission of the National Institutes of Health has provided support for systematic evaluation of clinical management, including the Multi-Purpose Arthritis Centers, the American Rheumatism Association Medical Information System, and the Cooperating Clinics, effectively complementing research in fundamental mechanisms of disease. The role of the concerned clinician and the clinical epidemiologist in identification of new syndromes and new diseases and in innovating approaches to their management has been extremely important; this role appears far from over.

Connective Tissue Diseases↗
PubMed1989

The compression of morbidity: near or far?

Compressing the period of infirmity into an ever-shorter period between the onset of morbidity and death might reduce the nation's illness burden; for this to occur, age-specific incidence of morbid states must decrease more rapidly than age-specific mortality rates. Recent data demonstrate that the onset of some major chronic illnesses is now being postponed and that increases in females' life expectancy have slowed. Large randomized controlled trials have shown an impact of primary prevention on morbidity exceeding that on mortality. These and other trends provide evidence for some degree of current compression of morbidity and suggest types of public health strategies required for further progress, including successful aging programs.

Chronic Disease↗