Bio

Academic Appointments


Honors & Awards


  • ISI Highly Cited, Web of Science (2009)
  • Research Hero, Arthritis Foundation (2000)
  • Cinical Research Award, American College of Rheumatology (2005)
  • Master of Rheumatology, American College of Rheumatology (2003)

Research & Scholarship

Current Research and Scholarly Interests


My research uses large longitudinal data banks of patients with chronic diseases, particularly rheumatic diseases, and senior individuals undergoing the aging process and related infirmities to perform studies of natural history of disease, toxicity of medications, identification of subsets of patients with special characteristics, prediction of high risk individuals, elaboration of treatment strategies, computation and the costs of care for chronic diseases, development of risk factor models for osteoarthritis and musculoskeletal aging, and other clinical epidemiologic subjects. The central resource is ARAMIS (Arthritis Rheumatism and Aging Medical Information System) which involves 17 centers in the United States and Canada and has just been refunded by the National Institutes of Health for years 26-30. Fellows are trained for academic positions in rheumatology or clinical epidemiology. Approximately 60 projects are underway at any given time and an excess of 900 peer reviewed publications have been published from the ARAMIS group of investigators. Related to the ARAMIS endeavors is the Post-Marketing Surveillance Program, which works with the AHCPR, the FDA, and industry to provide information on drug toxicities and drug benefits which were not well-documented or understood at the time of drug release. The studies employ pharmacoeconomic and pharmacoepidemiologic techniques. Information science applications are pursued by a technical computer programming staff. The ARAMIS staff include clinicians, epidemiologists, biostaticians, health economists, and health service researchers.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Upper-Extremity and Mobility Subdomains From the Patient-Reported Outcomes Measurement Information System (PROMIS) Adult Physical Functioning Item Bank ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Hays, R. D., Spritzer, K. L., Amtmann, D., Lai, J., DeWitt, E. M., Rothrock, N., DeWalt, D. A., Riley, W. T., Fries, J. F., Krishnan, E. 2013; 94 (11): 2291-2296

    Abstract

    To create upper-extremity and mobility subdomain scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning adult item bank.Expert reviews were used to identify upper-extremity and mobility items from the PROMIS item bank. Psychometric analyses were conducted to assess empirical support for scoring upper-extremity and mobility subdomains.Data were collected from the U.S. general population and multiple disease groups via self-administered surveys.The sample (N=21,773) included 21,133 English-speaking adults who participated in the PROMIS wave 1 data collection and 640 Spanish-speaking Latino adults recruited separately.Not applicable.We used English- and Spanish-language data and existing PROMIS item parameters for the physical functioning item bank to estimate upper-extremity and mobility scores. In addition, we fit graded response models to calibrate the upper-extremity items and mobility items separately, compare separate to combined calibrations, and produce subdomain scores.After eliminating items because of local dependency, 16 items remained to assess upper extremity and 17 items to assess mobility. The estimated correlation between upper extremity and mobility was .59 using existing PROMIS physical functioning item parameters (r=.60 using parameters calibrated separately for upper-extremity and mobility items).Upper-extremity and mobility subdomains shared about 35% of the variance in common, and produced comparable scores whether calibrated separately or together. The identification of the subset of items tapping these 2 aspects of physical functioning and scored using the existing PROMIS parameters provides the option of scoring these subdomains in addition to the overall physical functioning score.

    View details for DOI 10.1016/j.apmr.2013.05.014

    View details for Web of Science ID 000326852600035

    View details for PubMedID 23751290

  • Propensity-Adjusted Association of Methotrexate With Overall Survival in Rheumatoid Arthritis ARTHRITIS AND RHEUMATISM Wasko, M. C., Dasgupta, A., Hubert, H., Fries, J. F., Ward, M. M. 2013; 65 (2): 334-342

    Abstract

    While medications used to treat rheumatoid arthritis (RA) may affect survival in RA, few studies take into account the propensity for medication use, which may reflect selection bias in treatment allocation in survival models. We undertook this study to examine the relationship between methotrexate (MTX) use and mortality in RA, after controlling for individual propensity scores for MTX use.We studied 5,626 RA patients prospectively for 25 years to determine the risk of death associated with MTX use, modeled in time-varying Cox regression models. We used the random forest method to generate individual propensity scores for MTX use at study entry and during followup in a time-varying manner; these scores were included in the multivariate model. We also investigated whether selective discontinuation of MTX immediately prior to death altered the risk of mortality, and we examined the association of duration of MTX use with survival.During followup, 666 patients (12%) died. MTX use was associated with reduced risk of death (adjusted hazard ratio 0.30 [95% confidence interval 0.09-1.03]). Selective MTX cessation immediately before death did not account for the protective association of MTX use with mortality. Only MTX use for >1 year was associated with lower risks of mortality, but associations were not stronger with longer durations of use.MTX use was associated with a 70% reduction in mortality in RA.

    View details for DOI 10.1002/art.37723

    View details for Web of Science ID 000314169400007

    View details for PubMedID 23044791

  • Osteoarthritis, Exercise, and Knee Replacement JOURNAL OF RHEUMATOLOGY Fries, J. F., Bruce, B., Shoor, S. 2012; 39 (4): 669-671

    View details for DOI 10.3899/jrheum.111087

    View details for Web of Science ID 000302840800001

    View details for PubMedID 22467944

  • Disability outcomes and dose escalation with etanercept, adalimumab, and infliximab in rheumatoid arthritis patients: a US-based retrospective comparative effectiveness study CURRENT MEDICAL RESEARCH AND OPINION Schabert, V. F., Bruce, B., Ferrufino, C. F., Globe, D. R., Harrison, D. J., Lingala, B., Fries, J. F. 2012; 28 (4): 569-580

    Abstract

    Rheumatoid arthritis (RA) is a chronic disease that if left untreated may substantially impair physical functioning. Etanercept, infliximab, and adalimumab are tumor necrosis factor (TNF) blockers whose FDA-approved indications in the US include moderate to severe RA. TNF-blocker dose escalation has been well documented in the literature; however, the comparative effectiveness of these agents remains uncertain.To compare the effectiveness and dose escalation rates of etanercept, adalimumab, and infliximab in US community settings. We hypothesized that etanercept would be equivalent to infliximab and adalimumab in patient-reported disability 9-15 months after therapy initiation, and that fewer etanercept patients would experience dose escalation.This is a retrospective analysis of the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS). Adult patients with no biologic use 6 months before TNF-blocker initiation (index) and with Health Assessment Questionnaire Disability Index (HAQ-DI) scores at index and 9-15 months after index were analyzed (218 etanercept, 93 infliximab, and 40 adalimumab).HAQ-DI change scores at 9-15 months did not differ by treatment (-0.12, -0.10, and -0.08 points for etanercept, infliximab, and adalimumab, respectively; p = 0.52). Dose increases were observed in 1.4% of etanercept, 10.8% of infliximab (p < 0.001), and 12.5% of adalimumab patients (p = 0.004). HAQ-DI change was associated with pre-index HAQ-DI score (p < 0.0001) and disease duration (p = 0.001).Fewer etanercept patients escalated dose than infliximab or adalimumab patients, but improvements in functional disability were similar. These differences may have been influenced by package labeling, mode of administration, or other factors. RA treatment with infliximab and adalimumab in community settings, characterized by dose escalation, did not yield greater disability improvements compared to etanercept, which remained at a relatively stable dose. Uncontrolled treatment selection in this observational design may have influenced outcomes, and prior methotrexate treatment may partly explain disability improvements smaller than typically observed in clinical trials.

    View details for DOI 10.1185/03007995.2012.656844

    View details for Web of Science ID 000302751800009

    View details for PubMedID 22236091

  • Lifestyle Risk Factors Predict Disability and Death in Healthy Aging Adults AMERICAN JOURNAL OF MEDICINE Chakravarty, E. F., Hubert, H. B., Krishnan, E., Bruce, B. B., Lingala, V. B., Fries, J. F. 2012; 125 (2): 190-197

    Abstract

    Associations between modifiable health risk factors during middle age with disability and mortality in later life are critical to maximizing longevity while preserving function. Positive health effects of maintenance of normal weight, routine exercise, and nonsmoking are known for the short and intermediate term. We studied the effects of these risk factors into advanced age.A cohort of 2327 college alumnae aged 60 years or more was followed annually (1986-2005) by questionnaires addressing health risk factors, history, and Health Assessment Questionnaire disability. Mortality data were ascertained from the National Death Index. Low-, medium-, and high-risk groups were created on the basis of the number (0, 1, ?2) of health risk factors (overweight, smoking, inactivity) at baseline. Disability and mortality for each group were estimated from unadjusted data and regression analyses. Multivariable survival analyses estimated time to disability or death.The medium- and high-risk groups had higher disability than the low-risk group throughout the study (P<.001). Low-risk subjects had onset of moderate disability delayed 8.3 years compared with high-risk subjects. Mortality rates were higher in the high-risk group (384 vs 247 per 10,000 person-years). Multivariable survival analyses showed the number of risk factors to be associated with cumulative disability and increased mortality.Seniors with fewer behavioral risk factors during middle age have lower disability and improved survival. These data document that the associations of lifestyle risk factors on health continue into the ninth decade.

    View details for DOI 10.1016/j.amjmed.2011.08.006

    View details for Web of Science ID 000299531700023

    View details for PubMedID 22269623

  • Disability in rheumatoid arthritis in the era of biological treatments ANNALS OF THE RHEUMATIC DISEASES Krishnan, E., Lingala, B., Bruce, B., Fries, J. F. 2012; 71 (2): 213-218

    Abstract

    Rheumatoid arthritis (RA) is a disabling disease. The authors studied the impact of new, expensive and occasionally toxic biological treatments on disability outcomes in real-world populations of patients with RA.The authors analysed Health Assessment Questionnaire Disability Index data on 4651 adult patients with RA collected prospectively from 1983 to 2006. They studied trends in disability using multilevel mixed-effects multivariable linear regression (mixed) models that adjusted for the effects of time trends in gender, ethnicity, age, smoking behaviour and disease duration.Overall, the patients were predominantly female (76%), were predominantly white (88%), had 13 years of education and have had RA for 13 years, on average. The time period from 1983 to 2006 saw major increases in the use of disease-modifying agents and biological agents, and a decrease in smoking. After adjustments, the disability rates declined at annual rates of 1.7% (1.5-1.8%) overall and 2.7% (2.4-3.1%) among men. The annual rate of disability declines in the biological era was greater than that in the preceding period, suggesting accelerated improvement. These declines were documented in all patient subgroups such as men, women, African-Americans, obese, older age groups and early disease (p<0.001), but not among the 1401 patients (where disability remained stable) who died on follow-up.Aggressive use of traditional disease-modifying agents and introduction of biological agents were associated with substantial gains in disability outcomes. Our finding supports the prevailing notion that 'tight inflammation control' is a desirable therapeutic strategy.

    View details for DOI 10.1136/annrheumdis-2011-200354

    View details for Web of Science ID 000298681800009

    View details for PubMedID 21953343

  • Comparative risks of non-prescription analgesics: a structured topic review and research priorities EXPERT OPINION ON DRUG SAFETY Lavonas, E. J., Fries, J. F., Furst, D. E., Rothman, K. J., Stergachis, A., Vaida, A. J., Zelterman, D., Reynolds, K. M., Green, J. L., Dart, R. C. 2012; 11 (1): 33-44

    Abstract

    The aims of this report are to quantify and compare competing risks associated with the use of non-prescription analgesics (daily doses of acetaminophen ≤ 4000 mg, aspirin ≤ 4000 mg, ibuprofen ≤ 1200 mg, naproxen ≤ 660 mg and ketoprofen ≤ 75 mg) and identify research needs.Literature was searched and organized by medication, adverse effect and direction of effect. Causality was determined using structured consensus, using IOM and GRADE nomenclature. Magnitude of risk data were extracted from primary sources. Structured consensus were used to construct a list of research priorities.The available data favor acceptance of a causal relationship between each of the five analgesics studied and at least one specific form of harm. Dosing in excess of the non-prescription limits is associated with increased risk. Existing data do not support precise estimates of population or individual patient attributable risks for most analgesic and organ system combinations, and as a result competing risks cannot be adequately assessed. The highest priority research needs included understanding 'real world' dosing and how co-morbidities and prodromal symptoms modify exposure.Although generally safe, all non-prescription analgesics are associated with some harm, particularly when recommended dosing limits are exceeded. Research to quantify the competing risks of different analgesic strategies is urgently needed.

    View details for DOI 10.1517/14740338.2012.629782

    View details for Web of Science ID 000298386900005

    View details for PubMedID 22010836

  • The theory and practice of active aging. Current gerontology and geriatrics research Fries, J. F. 2012; 2012: 420637-?

    Abstract

    "Active aging" connotes a radically nontraditional paradigm of aging which posits possible improvement in health despite increasing longevity. The new paradigm is based upon postponing functional declines more than mortality declines and compressing morbidity into a shorter period later in life. This paradigm (Compression of Morbidity) contrasts with the old, where increasing longevity inevitably leads to increasing morbidity. We have focused our research on controlled longitudinal studies of aging. The Runners and Community Controls study began at age 58 in 1984 and the Health Risk Cohorts study at age 70 in 1986. We noted that disability was postponed by 14 to 16 years in vigorous exercisers compared with controls and postponed by 10 years in low-risk cohorts compared with higher risk. Mortality was also postponed, but too few persons had died for valid comparison of mortality and morbidity. With the new data presented here, age at death at 30% mortality is postponed by 7 years in Runners and age at death at 50% (median) mortality by 3.3 years compared to controls. Postponement of disability is more than double that of mortality in both studies. These differences increase over time, occur in all subgroups, and persist after statistical adjustment.

    View details for DOI 10.1155/2012/420637

    View details for PubMedID 23118746

  • Patient Perspective Workshop: Moving Towards OMERACT Guidelines for Choosing or Developing Instruments to Measure Patient-Reported Outcomes JOURNAL OF RHEUMATOLOGY Kirwan, J. R., Fries, J. F., Hewlett, S. E., Osborne, R. H., Newman, S., Ciciriello, S., van de Laar, M. A., Dures, E., Minnock, P., Heiberg, T., Sanderson, T. C., Flurey, C. A., Leong, A. L., Montie, P., Richards, P. 2011; 38 (8): 1711-1715

    Abstract

    The workshop Choosing or Developing Instruments held at the Outcome Measures in Rheumatology (OMERACT) 10 meeting was designed to help participants think about the underlying methods of instrument development. Conference pre-reading material and 3 brief introductory presentations elaborated the issues, and participants broke into discussion groups before reconvening to share insights, engage in a more general discussion of the issues, and vote on recommendations. Tradeoffs between using current imperfect measures and the long and complex process of developing new instruments were considered, together with the need for rigor in patient-reported outcome (PRO) instrument development. The main considerations for PRO instrument development were listed and a research agenda for action produced. As part of the agenda for action, it is recommended that researchers and patient partners work together to tackle these issues, and that OMERACT bring forward proposals for acceptable instrument development protocols that would meet an enhanced "Truth" statement in the OMERACT Filter.

    View details for DOI 10.3899/jrheum.110391

    View details for Web of Science ID 000293315000031

    View details for PubMedID 21807790

  • The PROMIS of Better Outcome Assessment: Responsiveness, Floor and Ceiling Effects, and Internet Administration JOURNAL OF RHEUMATOLOGY Fries, J., Rose, M., Krishnan, E. 2011; 38 (8): 1759-1764

    Abstract

    Use of item response theory (IRT) and, subsequently, computerized adaptive testing (CAT), under the umbrella of the NIH-PROMIS initiative (National Institutes of Health-Patient-Reported Outcomes Measurement Information System), to bring strong new assets to the development of more sensitive, more widely applicable, and more efficiently administered patient-reported outcome (PRO) instruments. We present data on current progress in 3 crucial areas: floor and ceiling effects, responsiveness to change, and interactive computer-based administration over the Internet.We examined nearly 1000 patients with rheumatoid arthritis and related diseases in a series of studies including a one-year longitudinal examination of detection of change; compared responsiveness of the Legacy SF-36 and HAQ-DI instruments with IRT-based instruments; performed a randomized head-to-head trial of 4 modes of item administration; and simulated the effect of lack of floor and ceiling items upon statistical power and sample sizes.IRT-based PROMIS instruments are more sensitive to change, resulting in the potential to reduce sample size requirements substantially by up to a factor of 4. The modes of administration tested did not differ from each other in any instance by more than one-tenth of a standard deviation. Floor and ceiling effects greatly reduce the number of available subjects, particularly at the ceiling.Failure to adequately address floor and ceiling effects, which determine the range of an instrument, can result in suboptimal assessment of many patients. Improved items, improved instruments, and computer-based administration improve PRO assessment and represent a fundamental advance in clinical outcomes research.

    View details for DOI 10.3899/jrheum.110402

    View details for Web of Science ID 000293315000039

    View details for PubMedID 21807798

  • Patient Perspective: Choosing or Developing Instruments JOURNAL OF RHEUMATOLOGY Kirwan, J. R., Fries, J. F., Hewlett, S., Osborne, R. H. 2011; 38 (8): 1716-1719

    Abstract

    Previous Outcome Measures in Rheumatology (OMERACT) meetings recognized that patients view outcomes of intervention from a different perspective. This preconference position paper briefly sets out 2 patient-reported outcome (PRO) instrument approaches, the PROMISE computer adaptive testing (CAT) system and development of a rheumatoid arthritis-specific questionnaire to measure fatigue; a tentative proposal for a PRO instrument development pathway is also made.

    View details for DOI 10.3899/jrheum.110390

    View details for Web of Science ID 000293315000032

    View details for PubMedID 21807791

  • Improved responsiveness and reduced sample size requirements of PROMIS physical function scales with item response theory ARTHRITIS RESEARCH & THERAPY Fries, J. F., Krishnan, E., Rose, M., Lingala, B., Bruce, B. 2011; 13 (5)

    Abstract

    The Health Assessment Questionnaire Disability Index (HAQ) and the SF-36 PF-10, among other instruments, yield sensitive and valid Disability (Physical Function) endpoints. Modern techniques, such as Item Response Theory (IRT), now enable development of more precise instruments using improved items. The NIH Patient Reported Outcomes Measurement Information System (PROMIS) is charged with developing improved IRT-based tools. We compared the ability to detect change in physical function using original (Legacy) instruments with Item-Improved and PROMIS IRT-based instruments.We studied two Legacy (original) Physical Function/Disability instruments (HAQ, PF-10), their item-improved derivatives (Item-Improved HAQ and PF-10), and the IRT-based PROMIS Physical Function 10- (PROMIS PF 10) and 20-item (PROMIS PF 20) instruments. We compared sensitivity to detect 12-month changes in physical function in 451 rheumatoid arthritis (RA) patients and assessed relative responsiveness using P-values, effect sizes (ES), and sample size requirements.The study sample was 81% female, 87% Caucasian, 65 years of age, had 14 years of education, and had moderate baseline disability. All instruments were sensitive to detecting change (< 0.05) in physical function over one year. The most responsive instruments in these patients were the Item-Improved HAQ and the PROMIS PF 20. IRT-improved instruments could detect a 1.2% difference with 80% power, while reference instruments could detect only a 2.3% difference (P < 0.01). The best IRT-based instruments required only one-quarter of the sample sizes of the Legacy (PF-10) comparator (95 versus 427). The HAQ outperformed the PF-10 in more impaired populations; the reverse was true in more normal populations. Considering especially the range of severity measured, the PROMIS PF 20 appears the most responsive instrument.Physical Function scales using item improved or IRT-based items can result in greater responsiveness and precision across a broader range of physical function. This can reduce sample size requirements and thus study costs.

    View details for DOI 10.1186/ar3461

    View details for Web of Science ID 000301174600007

    View details for PubMedID 21914216

  • Compression of morbidity 1980-2011: a focused review of paradigms and progress. Journal of aging research Fries, J. F., Bruce, B., Chakravarty, E. 2011; 2011: 261702-?

    Abstract

    The Compression of Morbidity hypothesis-positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability-was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based "healthy aging" interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity.

    View details for DOI 10.4061/2011/261702

    View details for PubMedID 21876805

  • The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008 JOURNAL OF CLINICAL EPIDEMIOLOGY Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., Cook, K., DeVellis, R., DeWalt, D., Fries, J. F., Gershon, R., Hahn, E. A., Lai, J., Pilkonis, P., Revicki, D., Rose, M., Weinfurt, K., Hays, R. 2010; 63 (11): 1179-1194

    Abstract

    Patient-reported outcomes (PROs) are essential when evaluating many new treatments in health care; yet, current measures have been limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The Patient-Reported Outcomes Measurement Information System (PROMIS) provides item banks that offer the potential for efficient (minimizes item number without compromising reliability), flexible (enables optional use of interchangeable items), and precise (has minimal error in estimate) measurement of commonly studied PROs. We report results from the first large-scale testing of PROMIS items.Fourteen item pools were tested in the U.S. general population and clinical groups using an online panel and clinic recruitment. A scale-setting subsample was created reflecting demographics proportional to the 2000 U.S. census.Using item-response theory (graded response model), 11 item banks were calibrated on a sample of 21,133, measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Short forms from each bank were developed and compared with the overall bank and with other well-validated and widely accepted ("legacy") measures. All item banks demonstrated good reliability across most of the score distributions. Construct validity was supported by moderate to strong correlations with legacy measures.PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. Further testing will continue to validate and test PROMIS items and banks in diverse clinical populations.

    View details for DOI 10.1016/j.jclinepi.2010.04.011

    View details for Web of Science ID 000282861600004

    View details for PubMedID 20685078

  • A first step to assess harm and benefit in clinical trials in one scale JOURNAL OF CLINICAL EPIDEMIOLOGY Boers, M., Brooks, P., Fries, J. F., Simon, L. S., Strand, V., Tugwell, P. 2010; 63 (6): 627-632

    Abstract

    To develop a simple system to assess benefit and harm of treatment on a single scale. Harm and benefit signals from trials need to be placed in the proper perspective to decide on the value of a treatment. Several systems have been developed for assessment, but few attempt to incorporate both benefit and risk in the same metric while retaining enough simplicity to aid patients and clinicians in their decision making.We designed a very simple 3 x 3 table (Outcome Measures in Rheumatology [OMERACT] 3 x 3) that comprises three ranks for both beneficial and harm outcomes: for benefit, these are "none," "substantial," and "(near) remission"; for harm, these are "none," "severe," and "(near) death." Patients are ranked both for benefit and harm and subsequently counted in a 3 x 3 table.The system was feasible when applied to one trial dataset (patient-level information) and a meta-analysis. To become applicable as a tool, several issues need to be resolved in further development, especially the definitions and cutoffs for the ranks.A simple 3 x 3 table to rank both benefit and harm outcomes is feasible. For rheumatology this will be further developed in the context of the OMERACT initiative.

    View details for DOI 10.1016/j.jclinepi.2009.07.002

    View details for Web of Science ID 000277663900009

    View details for PubMedID 19800197

  • How to Ascertain Drug Safety in the Context of Benefit. Controversies and Concerns JOURNAL OF RHEUMATOLOGY Simon, L. S., Strand, C. V., Boers, M., Brooks, P. M., Tugwell, P. S., Bombardier, C., Fries, J. F., Henry, D., Goldkind, L., Guyatt, G., Laupacis, A., Lynd, L., MacDonald, T., Mamdani, M., Moore, A., Saag, K. S., Silman, A. J., Stevens, R., Tyndall, A. 2009; 36 (9): 2114-2121

    Abstract

    There is great concern about clearly defining benefit and risk in the context of both drug development and clinical practice. In view of this pressure, the OMERACT Executive identified the need to bring together clinical trialists, pharmacoepidemiologists, clinicians, clinical epidemiologists, statistical experts, and regulatory representatives to discuss different approaches to define risk and perhaps improved ways to express it. Each attendee spoke on a given topic and the group was charged to consider the issue of risk in the context of formally posed questions. This article provides a summary of the presentations and outlines the discussions that followed.

    View details for DOI 10.3899/jrheum.090591

    View details for Web of Science ID 000269677600048

    View details for PubMedID 19738223

  • Progress in Assessing Physical Function in Arthritis: PROMIS Short Forms and Computerized Adaptive Testing JOURNAL OF RHEUMATOLOGY Fries, J. F., Cella, D., Rose, M., Krishnan, E., Bruce, B. 2009; 36 (9): 2061-2066

    Abstract

    Assessing self-reported physical function/disability with the Health Assessment Questionnaire Disability Index (HAQ) and other instruments has become central in arthritis research. Item response theory (IRT) and computerized adaptive testing (CAT) techniques can increase reliability and statistical power. IRT-based instruments can improve measurement precision substantially over a wider range of disease severity. These modern methods were applied and the magnitude of improvement was estimated.A 199-item physical function/disability item bank was developed by distilling 1865 items to 124, including Legacy Health Assessment Questionnaire (HAQ) and Physical Function-10 items, and improving precision through qualitative and quantitative evaluation in over 21,000 subjects, which included about 1500 patients with rheumatoid arthritis and osteoarthritis. Four new instruments, (A) Patient-Reported Outcomes Measurement Information (PROMIS) HAQ, which evolved from the original (Legacy) HAQ; (B) "best" PROMIS 10; (C) 20-item static (short) forms; and (D) simulated PROMIS CAT, which sequentially selected the most informative item, were compared with the HAQ.Online and mailed administration modes yielded similar item and domain scores. The HAQ and PROMIS HAQ 20-item scales yielded greater information content versus other scales in patients with more severe disease. The "best" PROMIS 20-item scale outperformed the other 20-item static forms over a broad range of 4 standard deviations. The 10-item simulated PROMIS CAT outperformed all other forms.Improved items and instruments yielded better information. The PROMIS HAQ is currently available and considered validated. The new PROMIS short forms, after validation, are likely to represent further improvement. CAT-based physical function/disability assessment offers superior performance over static forms of equal length.

    View details for DOI 10.3899/jrheum.090358

    View details for Web of Science ID 000269677600039

    View details for PubMedID 19738214

  • What constitutes progress in assessing patient outcomes? JOURNAL OF CLINICAL EPIDEMIOLOGY Fries, J. F., Krishnan, E. 2009; 62 (8): 779-780

    Abstract

    Patient self-reported disability outcomes, measured using instruments such as the Health Assessment Questionnaire Disability Index (HAQ-DI) form a foundation for clinical studies of several conditions, notably arthritis. These instruments are "static" because the instrument is the same in all applications. Although generally performing well, they may fail at extremes of disability, the so-called floor and ceiling effects. Another limitation is the degree of measurement error, the signal-to-noise ratio. These two issues drive down the statistical power of clinical trials and increase their expense.

    View details for DOI 10.1016/j.jclinepi.2008.12.001

    View details for Web of Science ID 000268200300001

    View details for PubMedID 19282147

  • Items, Instruments, Crosswalks, and PROMIS JOURNAL OF RHEUMATOLOGY Fries, J. F., Krishnan, E., Bruce, B. 2009; 36 (6): 1093-1095

    View details for DOI 10.3899/jrheum.090320

    View details for Web of Science ID 000266891500001

    View details for PubMedID 19509084

  • Rheumatologist Perceptions of Sources of Health Care Disparities in Minority Rheumatoid Arthritis Patients JCR-JOURNAL OF CLINICAL RHEUMATOLOGY Bruce, B., Fries, J. F. 2009; 15 (3): 145-147

    View details for DOI 10.1097/RHU.0b013e31819e6b57

    View details for Web of Science ID 000265179700013

    View details for PubMedID 19300281

  • Better assessment of physical function: item improvement is neglected but essential ARTHRITIS RESEARCH & THERAPY Bruce, B., Fries, J. F., Ambrosini, D., Lingala, B., Gandek, B., Rose, M., Ware, J. E. 2009; 11 (6)

    Abstract

    Physical function is a key component of patient-reported outcome (PRO) assessment in rheumatology. Modern psychometric methods, such as Item Response Theory (IRT) and Computerized Adaptive Testing, can materially improve measurement precision at the item level. We present the qualitative and quantitative item-evaluation process for developing the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function item bank.The process was stepwise: we searched extensively to identify extant Physical Function items and then classified and selectively reduced the item pool. We evaluated retained items for content, clarity, relevance and comprehension, reading level, and translation ease by experts and patient surveys, focus groups, and cognitive interviews. We then assessed items by using classic test theory and IRT, used confirmatory factor analyses to estimate item parameters, and graded response modeling for parameter estimation. We retained the 20 Legacy (original) Health Assessment Questionnaire Disability Index (HAQ-DI) and the 10 SF-36's PF-10 items for comparison. Subjects were from rheumatoid arthritis, osteoarthritis, and healthy aging cohorts (n = 1,100) and a national Internet sample of 21,133 subjects.We identified 1,860 items. After qualitative and quantitative evaluation, 124 newly developed PROMIS items composed the PROMIS item bank, which included revised Legacy items with good fit that met IRT model assumptions. Results showed that the clearest and best-understood items were simple, in the present tense, and straightforward. Basic tasks (like dressing) were more relevant and important versus complex ones (like dancing). Revised HAQ-DI and PF-10 items with five response options had higher item-information content than did comparable original Legacy items with fewer response options. IRT analyses showed that the Physical Function domain satisfied general criteria for unidimensionality with one-, two-, three-, and four-factor models having comparable model fits. Correlations between factors in the test data sets were > 0.90.Item improvement must underlie attempts to improve outcome assessment. The clear, personally important and relevant, ability-framed items in the PROMIS Physical Function item bank perform well in PRO assessment. They will benefit from further study and application in a wider variety of rheumatic diseases in diverse clinical groups, including those at the extremes of physical functioning, and in different administration modes.

    View details for DOI 10.1186/ar2890

    View details for Web of Science ID 000278282100031

    View details for PubMedID 20015354

  • Reduced disability and mortality among aging runners - A 21-year longitudinal study ARCHIVES OF INTERNAL MEDICINE Chakravarty, E. F., Hubert, H. B., Lingala, V. B., Fries, J. F. 2008; 168 (15): 1638-1646

    Abstract

    Exercise has been shown to improve many health outcomes and well-being of people of all ages. Long-term studies in older adults are needed to confirm disability and survival benefits of exercise.Annual self-administered questionnaires were sent to 538 members of a nationwide running club and 423 healthy controls from northern California who were 50 years and older beginning in 1984. Data included running and exercise frequency, body mass index, and disability assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI; scored from 0 [no difficulty] to 3 [unable to perform]) through 2005. A total of 284 runners and 156 controls completed the 21-year follow-up. Causes of death through 2003 were ascertained using the National Death Index. Multivariate regression techniques compared groups on disability and mortality.At baseline, runners were younger, leaner, and less likely to smoke compared with controls. The mean (SD) HAQ-DI score was higher for controls than for runners at all time points and increased with age in both groups, but to a lesser degree in runners (0.17 [0.34]) than in controls (0.36 [0.55]) (P < .001). Multivariate analyses showed that runners had a significantly lower risk of an HAQ-DI score of 0.5 (hazard ratio, 0.62; 95% confidence interval, 0.46-0.84). At 19 years, 15% of runners had died compared with 34% of controls. After adjustment for covariates, runners demonstrated a survival benefit (hazard ratio, 0.61; 95% confidence interval, 0.45-0.82). Disability and survival curves continued to diverge between groups after the 21-year follow-up as participants approached their ninth decade of life.Vigorous exercise (running) at middle and older ages is associated with reduced disability in later life and a notable survival advantage.

    View details for Web of Science ID 000258261100005

    View details for PubMedID 18695077

  • Long distance running and knee osteoarthritis - A prospective study AMERICAN JOURNAL OF PREVENTIVE MEDICINE Chakravarty, E. F., Hubert, H. B., Lingala, V. B., Zatarain, E., Fries, J. F. 2008; 35 (2): 133-138

    Abstract

    Prior studies of the relationship of physical activity to osteoarthritis (OA) of the knee have shown mixed results. The objective of this study was to determine if differences in the progression of knee OA in middle- to older-aged runners exist when compared with healthy nonrunners over nearly 2 decades of serial radiographic observation.Forty-five long-distance runners and 53 controls with a mean age of 58 (range 50-72) years in 1984 were studied through 2002 with serial knee radiographs. Radiographic scores were two-reader averages for Total Knee Score (TKS) by modified Kellgren & Lawrence methods. TKS progression and the number of knees with severe OA were compared between runners and controls. Multivariate regression analyses were performed to assess the relationship between runner versus control status and radiographic outcomes using age, gender, BMI, education, and initial radiographic and disability scores among covariates.Most subjects showed little initial radiographic OA (6.7% of runners and 0 controls); however, by the end of the study runners did not have more prevalent OA (20 vs 32%, p =0.25) nor more cases of severe OA (2.2% vs 9.4%, p=0.21) than did controls. Regression models found higher initial BMI, initial radiographic damage, and greater time from initial radiograph to be associated with worse radiographic OA at the final assessment; no significant associations were seen with gender, education, previous knee injury, or mean exercise time.Long-distance running among healthy older individuals was not associated with accelerated radiographic OA. These data raise the possibility that severe OA may not be more common among runners.

    View details for DOI 10.1016/j.amepre.2008.03.032

    View details for Web of Science ID 000257893700007

    View details for PubMedID 18550323

  • Regular vigorous physical activity and disability development in healthy overweight and normal-weight seniors: A 13-year study AMERICAN JOURNAL OF PUBLIC HEALTH Bruce, B., Fries, J. F., Hubert, H. 2008; 98 (7): 1294-1299

    Abstract

    We examined the relationship of regular exercise and body weight to disability among healthy seniors.We assessed body mass index (BMI) and vigorous exercise yearly (1989-2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4 groups: normal-weight active (BMI< 25 kg/m(2); exercise> 60 min/wk); normal-weight inactive (exerciseor= 25 kg/m(2)); and overweight inactive. Disability was measured with the Health Assessment Questionnaire (0-3; 0= no difficulty, 3= unable to do). We used multivariable analysis of covariance to determine group differences in disability scores after adjustment for determinants of disability.The cohort was 72% men and 96% White, with a mean age of 65.2 years. After 13 years, overweight active participants had significantly less disability than did overweight inactive (0.14 vs 0.19; P= .001) and normal-weight inactive (0.22; P= .03) participants. Similar differences were found between normal-weight active (0.11) and normal-weight inactive participants (P< .001).Being physically active mitigated development of disability in these seniors, largely independent of BMI. Public health efforts that promote physically active lifestyles among seniors may be more successful than those that emphasize body weight in the prevention of functional decline.

    View details for DOI 10.2105/AJPH.2007.119909

    View details for Web of Science ID 000257202700029

    View details for PubMedID 18511724

  • Comparison of the Health Assessment Questionnaire disability index and the Short Form 36 physical functioning subscale using Rasch analysis: comment on the article by Taylor and McPherson ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH Fries, J. F., Bruce, B., Rose, M. 2008; 59 (4): 598-599

    View details for DOI 10.1002/art.23520

    View details for Web of Science ID 000254983400021

    View details for PubMedID 18383400

  • Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS) JOURNAL OF CLINICAL EPIDEMIOLOGY Rose, M., Bjomer, J. B., Becker, J., Fries, J. F., Ware, J. E. 2008; 61 (1): 17-33

    Abstract

    The Patient-Reported Outcomes Measurement Information System (PROMIS) was initiated to improve precision, reduce respondent burden, and enhance the comparability of health outcomes measures. We used item response theory (IRT) to construct and evaluate a preliminary item bank for physical function assuming four subdomains.Data from seven samples (N=17,726) using 136 items from nine questionnaires were evaluated. A generalized partial credit model was used to estimate item parameters, which were normed to a mean of 50 (SD=10) in the US population. Item bank properties were evaluated through Computerized Adaptive Test (CAT) simulations.IRT requirements were fulfilled by 70 items covering activities of daily living, lower extremity, and central body functions. The original item context partly affected parameter stability. Items on upper body function, and need for aid or devices did not fit the IRT model. In simulations, a 10-item CAT eliminated floor and decreased ceiling effects, achieving a small standard error (< 2.2) across scores from 20 to 50 (reliability >0.95 for a representative US sample). This precision was not achieved over a similar range by any comparable fixed length item sets.The methods of the PROMIS project are likely to substantially improve measures of physical function and to increase the efficiency of their administration using CAT.

    View details for DOI 10.1016/j.jclinepi.2006.06.025

    View details for Web of Science ID 000252044900004

    View details for PubMedID 18083459

  • Primary knee and hip arthroplasty among nonagenarians and centenarians in the United States ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH Krishnan, E., Fries, J. F., Kwoh, C. K. 2007; 57 (6): 1038-1042

    Abstract

    The number of individuals ages >or=100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on the poorly studied epidemiology and mortality outcomes of arthroplasty among these individuals.We describe the epidemiology of knee and hip arthroplasties among centenarians using data from a large hospital discharge database in the US (the Nationwide Inpatient Sample) during the period 1993 through 2002. We used nonagenarians as the comparison group with adjustment for differences in the prevalence of congestive heart failure, neurologic diseases such as dementia and stroke, renal and hepatic diseases, obesity, anemia, malignancy, coagulopathy, and depression and other psychiatric illnesses. Cox regression models were used to study the mortality outcomes following arthroplasty.Overall, there were 679 hip arthroplasties and 7 knee arthroplasties among centenarians in this database. The corresponding figures for nonagenarians were 33,975 and 2,050, respectively. A vast majority (83%) of hip arthroplasty recipients were women. Risk-adjusted mortality estimates following arthroplasty for centenarians were higher than for nonagenarians (hazard ratio 1.46, 95% confidence interval 1.10-1.95). However, this was similar to differences in overall in-hospital mortality (hazard ratio 1.36, 95% confidence interval 1.32-1.40) between these 2 age categories.In the US population, hip and knee arthroplasty are very rarely performed among centenarians. Our in-hospital mortality data suggest that arthroplasties should not be denied to centenarians solely because of short-term postoperative life expectancy estimates.

    View details for DOI 10.1002/art.22888

    View details for Web of Science ID 000248705800021

    View details for PubMedID 17665474

  • Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wasko, M. C., Hubert, H. B., Lingala, V. B., Elliott, J. R., Luggen, M. E., Fries, J. F., Ward, M. M. 2007; 298 (2): 187-193

    Abstract

    Hydroxychloroquine, a commonly used antirheumatic medication, has hypoglycemic effects and may reduce the risk of diabetes mellitus.To determine the association between hydroxychloroquine use and the incidence of self-reported diabetes in a cohort of patients with rheumatoid arthritis.A prospective, multicenter observational study of 4905 adults with rheumatoid arthritis (1808 had taken hydroxychloroquine and 3097 had never taken hydroxychloroquine) and no diagnosis or treatment for diabetes in outpatient university-based and community-based rheumatology practices with 21.5 years of follow-up (January 1983 through July 2004).Diabetes by self-report of diagnosis or hypoglycemic medication use.During the observation period, incident diabetes was reported by 54 patients who had taken hydroxychloroquine and by 171 patients who had never taken hydroxychloroquine, with incidence rates of 5.2 per 1000 patient-years of observation compared with 8.9 per 1000 patient-years of observation, respectively (P < .001). In time-varying multivariable analysis with adjustments for possible confounding factors, the hazard ratio for incident diabetes among patients who had taken hydroxychloroquine was 0.62 (95% confidence interval, 0.42-0.92) compared with those who had not taken hydroxychloroquine. In Poisson regression, the risk of incident diabetes was significantly reduced with increased duration of hydroxychloroquine use (P < .001 for trend); among those taking hydroxychloroquine for more than 4 years (n = 384), the adjusted relative risk of developing diabetes was 0.23 (95% confidence interval, 0.11-0.50; P < .001), compared with those who had not taken hydroxychloroquine.Among patients with rheumatoid arthritis, use of hydroxychloroquine is associated with a reduced risk of diabetes.

    View details for Web of Science ID 000247910600024

    View details for PubMedID 17622600

  • Health status disparities in ethnic minority patients with rheumatoid arthritis: A cross-sectional study JOURNAL OF RHEUMATOLOGY Bruce, B., Fries, J. F., Murtagh, K. N. 2007; 34 (7): 1475-1479

    Abstract

    To examine disparities in disability, pain, and global health between Caucasian (n = 4294) and African American (n = 283) and Caucasian and Hispanic (n = 153) patients with rheumatoid arthritis (RA).Patients were from 9 Arthritis, Rheumatism, and Aging Medical Information System databanks. Cross-sectional data were derived from the Health Assessment Questionnaire. Staged multivariate analysis of covariance was used to explore roles of possible contributing factors (age, sex, education, disease duration, number of comorbid conditions, and treatment) to ethnic minority disparities.The cohort was 91% Caucasian and 76% female. Caucasians were significantly older than African Americans and Hispanics (62 vs 56 and 55 yrs; both p < 0.0001 from Caucasians), better educated (13 vs 12 and 12 yrs; both p < 0.0001 from Caucasians), and had their RA longer (16 vs 13 and 15 yrs; p < 0.01 for African Americans). Unadjusted disability scores were statistically indistinguishable, but pain was worse in both ethnic groups (p < 0.01), and global health worse in Hispanics (p < 0.05). After adjustment for covariates, African Americans had the poorest outcomes in all 3 measures, although only pain in African Americans (p < 0.05) was statistically different from Caucasians.Results of this exploratory study suggest that in a relatively similar cohort of patients with RA, minority health disparities exist. Both ethnic groups had poorer outcomes for all 3 measures than Caucasians after adjustment. Additional study and longitudinal research with larger numbers of patients are needed to improve our understanding of these differences and to assess potential causal roles.

    View details for Web of Science ID 000248017700008

    View details for PubMedID 17552045

  • Proteomic analysis of secreted proteins in early rheumatoid arthritis: anti-citrulline autoreactivity is associated with up regulation of proinflammatory cytokines ANNALS OF THE RHEUMATIC DISEASES Hueber, W., Tomooka, B. H., Zhao, X., Kidd, B. A., Drijfhout, J. W., Fries, J. F., van Venrooij, W. J., Metzger, A. L., Genovese, M. C., Robinson, W. H. 2007; 66 (6): 712-719

    Abstract

    To identify peripheral blood autoantibody and cytokine profiles that characterise clinically relevant subgroups of patients with early rheumatoid arthritis using arthritis antigen microarrays and a multiplex cytokine assay.Serum samples from 56 patients with a diagnosis of rheumatoid arthritis of <6 months' duration were tested. Cytokine profiles were also determined in samples from patients with psoriatic arthritis (PsA) and ankylosing spondylitis (n = 21), and from healthy individuals (n = 19). Data were analysed using Kruskal-Wallis test with Dunn's adjustment for multiple comparisons, linear correlation tests, significance analysis of microarrays (SAM) and hierarchical clustering software.Distinct antibody profiles were associated with subgroups of patients who exhibited high serum levels of tumour necrosis factor (TNF)alpha, interleukin (IL)1beta, IL6, IL13, IL15 and granulocyte macrophage colony-stimulating factor. Significantly increased autoantibody reactivity against citrullinated epitopes was observed in patients within the cytokine "high" subgroup. Increased levels of TNFalpha, IL1alpha, IL12p40 and IL13, and the chemokines eotaxin/CCL11, monocyte chemoattractant protein-1 and interferon-inducible protein 10, were present in early rheumatoid arthritis as compared with controls (p<0.001). Chemokines showed some of the most impressive differences. Only IL8/CXCL8 concentrations were higher in patients with PsA/ankylosing spondylitis (p = 0.02).Increased blood levels of proinflammatory cytokines are associated with autoantibody targeting of citrullinated antigens and surrogate markers of disease activity in patients with early rheumatoid arthritis. Proteomic analysis of serum autoantibodies, cytokines and chemokines enables stratification of patients with early rheumatoid arthritis into molecular subgroups.

    View details for DOI 10.1136/ard.2006.054924

    View details for Web of Science ID 000246594700002

    View details for PubMedID 16901957

  • Improving patient reported outcomes using item response theory and computerized adaptive testing JOURNAL OF RHEUMATOLOGY Chakravarty, E. F., Bjorner, J. B., Fries, J. F. 2007; 34 (6): 1426-1431

    Abstract

    Patient reported outcomes (PRO) are considered central outcome measures for both clinical trials and observational studies in rheumatology. More sophisticated statistical models, including item response theory (IRT) and computerized adaptive testing (CAT), will enable critical evaluation and reconstruction of currently utilized PRO instruments to improve measurement precision while reducing item burden on the individual patient.We developed a domain hierarchy encompassing the latent trait of physical function/disability from the more general to most specific. Items collected from 165 English-language instruments were evaluated by a structured process including trained raters, modified Delphi expert consensus, and then patient evaluation. Each item in the refined data bank will undergo extensive analysis using IRT to evaluate response functions and measurement precision. CAT will allow for real-time questionnaires of potentially smaller numbers of questions tailored directly to each individual's level of physical function.Physical function/disability domain comprises 4 subdomains: upper extremity, trunk, lower extremity, and complex activities. Expert and patient review led to consensus favoring use of present-tense "capability" questions using a 4- or 5-item Likert response construct over past-tense "performance"items. Floor and ceiling effects, attribution of disability, and standardization of response categories were also addressed.By applying statistical techniques of IRT through use of CAT, existing PRO instruments may be improved to reduce questionnaire burden on the individual patients while increasing measurement precision that may ultimately lead to reduced sample size requirements for costly clinical trials.

    View details for Web of Science ID 000247116600034

    View details for PubMedID 17552069

  • The Patient-Reported Outcomes Measurement Information System (PROMIS) Progress of an NIH roadmap cooperative group during its first two years MEDICAL CARE Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., Ader, D., Fries, J. F., Bruce, B., Rose, M. 2007; 45 (5): S3-S11

    Abstract

    The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Roadmap initiative (www.nihpromis.org) is a 5-year cooperative group program of research designed to develop, validate, and standardize item banks to measure patient-reported outcomes (PROs) relevant across common medical conditions. In this article, we will summarize the organization and scientific activity of the PROMIS network during its first 2 years.The network consists of 6 primary research sites (PRSs), a statistical coordinating center (SCC), and NIH research scientists. Governed by a steering committee, the network is organized into functional subcommittees and working groups. In the first year, we created an item library and activated 3 interacting protocols: Domain Mapping, Archival Data Analysis, and Qualitative Item Review (QIR). In the second year, we developed and initiated testing of item banks covering 5 broad domains of self-reported health.The domain mapping process is built on the World Health Organization (WHO) framework of physical, mental, and social health. From this framework, pain, fatigue, emotional distress, physical functioning, social role participation, and global health perceptions were selected for the first wave of testing. Item response theory (IRT)-based analysis of 11 large datasets supplemented and informed item-level qualitative review of nearly 7000 items from available PRO measures in the item library. Items were selected for rewriting or creation with further detailed review before the first round of testing in the general population and target patient populations.The NIH PROMIS network derived a consensus-based framework for self-reported health, systematically reviewed available instruments and datasets that address the initial PROMIS domains. Qualitative item research led to the first wave of network testing which began in the second year.

    View details for Web of Science ID 000246462400002

    View details for PubMedID 17443116

  • The irreversible component of the disability index of the Health Assessment Questionnaire: comment on the article by Aletaha et al ARTHRITIS AND RHEUMATISM Fries, J. F. 2007; 56 (4): 1368-1369

    View details for DOI 10.1002/art.22517

    View details for Web of Science ID 000245845100038

    View details for PubMedID 17393444

  • More relevant, precise, and efficient items for assessment of physical function and disability: moving beyond the classic instruments ANNALS OF THE RHEUMATIC DISEASES Fries, J. F., Bruce, B., Bjorner, J., Rose, M. 2006; 65: 16-21
  • More relevant, precise, and efficient items for assessment of physical function and disability: moving beyond the classic instruments. Annals of the rheumatic diseases Fries, J. F., Bruce, B., Bjorner, J., Rose, M. 2006; 65: iii16-21

    Abstract

    Patient reported outcomes (PROs) have become standard study endpoints. However, little attention has been given to using item improvement to advance PRO performance which could improve precision, clarity, patient relevance, and information content of "physical function/disability" items and thus the performance of resulting instruments.The present study included 1860 physical function/disability items from 165 instruments. Item formulations were assessed by frequency of use, modified Delphi consensus, respondent judgement of clarity and importance, and item response theory (IRT). Data from 1100 rheumatoid arthritis, osteoarthritis, and normal ageing subjects, using qualitative item review, focus groups, cognitive interviews, and patient survey were used to achieve a unique item pool that was clear, reliable, sensitive to change, readily translatable, devoid of floor and ceiling limitations, contained unidimensional subdomains, and had maximal information content.A "present tense" time frame was used most frequently, better understood, more readily translated, and more directly estimated the latent trait of disability. Items in the "past tense" had 80-90% false negatives (p<0.001). The best items were brief, clear, and contained a single construct. Responses with four to five options were preferred by both experts and respondents. The term physical function may be preferable to the term disability because of fewer floor effects. IRT analyses of "disability" suggest four independent subdomains (mobility, dexterity, axial, and compound) with factor loadings of 0.81-0.99.Major improvement in performance of items and instruments is possible, and may have the effect of substantially reducing sample size requirements for clinical trials.

    View details for PubMedID 17038464

  • A low tension between individual and societal time aspects in health improved outcomes JOURNAL OF CLINICAL EPIDEMIOLOGY Ortendahl, M., Fries, J. F. 2006; 59 (11): 1222-1227

    Abstract

    To review intertemporal choices, involving decisions with a trade-off between something now and something later. These choices are common in health both at an individual and societal level.The present value of an outcome, for example, the amount of money or the health outcomes in various aspects, is equivalent to the value of a future outcome discounted with the delay of time. The concept of diminishing value over time is positive discounting. Economic forecasts generally use discount rates in which the value of a future dollar is less than the value of a present dollar, and where the discount rates are similar for the individual investor and society. The value of future health is commonly thought of as similar to the value of future money. Yet, the individual may rationally choose a discount rate that is exceedingly low or even negative. This paradox is particularly relevant when considering primary and secondary prevention, where initial and continuing costs may precede beneficent outcomes by decades, making discount rate selections the dominant factor in determining decisions.We suggest that the societal perspective should also recognize that discount rates for health outcomes are largely irrelevant and that even negative discount rates have crucial relevance.

    View details for DOI 10.1016/j.jclinepi.2005.12.018

    View details for Web of Science ID 000241370000014

    View details for PubMedID 17027434

  • Science as experiment; science as observation NATURE CLINICAL PRACTICE RHEUMATOLOGY Chakravarty, E. F., Fries, J. F. 2006; 2 (6): 286-287

    View details for DOI 10.1038/ncprheum0192

    View details for Web of Science ID 000237906700002

    View details for PubMedID 16932703

  • Discounting and risk characteristics in clinical decision-making MEDICAL SCIENCE MONITOR Ortendahl, M., Fries, J. F. 2006; 12 (3): RA41-RA45

    Abstract

    Time-related aspects have attracted an increasing interest in medical decisions. Health promotion often works toward remote goals, and many clinical judgments and decisions include an exchange of costs today for benefits in the future. The concept of diminishing value over time is positive discounting when the benefits occur so far in the future that they seem of little value relative to the immediate cost. If there is a preference to live for the present rather than save for the future, such a preference might not contribute to good health according to a lower discount rate. As discounting is related to risk an analysis of uncertainty is required being an unavoidable condition in health work. Shared decision-making between doctor and patient has increasingly been emphasized, where risk characteristics and time-related aspects should be taken into account to reach a decision based upon mutual agreement. The framework of time and risk for analysis can perform a useful role in clinical judgments and decisions, where framing of different features of risk might diminish discounting and increase compliance to treatment. A summary of valuation factors in medical decision making is presented: (a) long-term decisions are sensitive to discount rates; (b) discount rates vary by domain, by outcome, by individuals and by level of certainty; (c) probability discounting is used if the risk is perceived as controllable; (d) the doctor uses expected value, the patient is risk aversive; (e) asymmetric discounting for patients and doctors gives poor compliance; (f) discount rates are influenced by framing.

    View details for Web of Science ID 000236071000019

    View details for PubMedID 16501432

  • Midlife body mass index and hospitalization and mortality in older age JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Yan, L. J., Daviglus, M. L., Liu, K., Stamler, J., Wang, R. W., Pirzada, A., Garside, D. B., Dyer, A. R., Van Horn, L., Liao, Y. L., Fries, J. F., Greenland, P. 2006; 295 (2): 190-198

    Abstract

    Abundant evidence links overweight and obesity with impaired health. However, controversies persist as to whether overweight and obesity have additional impact on cardiovascular outcomes independent of their strong associations with established coronary risk factors, eg, high blood pressure and high cholesterol level.To assess the relation of midlife body mass index with morbidity and mortality outcomes in older age among individuals without and with other major risk factors at baseline.Chicago Heart Association Detection Project in Industry study, a prospective study with baseline (1967-1973) cardiovascular risk classified as low risk (blood pressure < or =120/< or =80 mm Hg, serum total cholesterol level <200 mg/dL [5.2 mmol/L], and not currently smoking); moderate risk (nonsmoking and systolic blood pressure 121-139 mm Hg, diastolic blood pressure 81-89 mm Hg, and/or total cholesterol level 200-239 mg/dL [5.2-6.2 mmol/L]); or having any 1, any 2, or all 3 of the following risk factors: blood pressure > or =140/90 mm Hg, total cholesterol level > or =240 mg/dL (6.2 mmol/L), and current cigarette smoking. Body mass index was classified as normal weight (18.5-24.9), overweight (25.0-29.9), or obese (> or =30). Mean follow-up was 32 years.Participants were 17,643 men and women aged 31 through 64 years, recruited from Chicago-area companies or organizations and free of coronary heart disease (CHD), diabetes, or major electrocardiographic abnormalities at baseline.Hospitalization and mortality from CHD, cardiovascular disease, or diabetes, beginning at age 65 years.In multivariable analyses that included adjustment for systolic blood pressure and total cholesterol level, the odds ratio (95% confidence interval) for CHD death for obese participants compared with those of normal weight in the same risk category was 1.43 (0.33-6.25) for low risk and 2.07 (1.29-3.31) for moderate risk; for CHD hospitalization, the corresponding results were 4.25 (1.57-11.5) for low risk and 2.04 (1.29-3.24) for moderate risk. Results were similar for other risk groups and for cardiovascular disease, but stronger for diabetes (eg, low risk: 11.0 [2.21-54.5] for mortality and 7.84 [3.95-15.6] for hospitalization).For individuals with no cardiovascular risk factors as well as for those with 1 or more risk factors, those who are obese in middle age have a higher risk of hospitalization and mortality from CHD, cardiovascular disease, and diabetes in older age than those who are normal weight.

    View details for Web of Science ID 000234544300026

    View details for PubMedID 16403931

  • Associations of changes in exercise level with subsequent disability among seniors: A 16-year longitudinal study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Berk, D. R., Hubert, H. B., Fries, J. F. 2006; 61 (1): 97-102

    Abstract

    The effect of changes in physical exercise on progression of musculoskeletal disability in seniors has rarely been studied.We studied a prospective cohort annually from 1984 to 2000 using the Health Assessment Questionnaire Disability Index (HAQ-DI). The cohort included 549 participants, 73% men, with average end-of-study age of 74 years. At baseline and at the end of the study, participants were classified as "High" or "Low" vigorous exercisers using a cut-point of 60 min/wk. Four groups were formed: "Sedentary" (Low-->Low; N = 71), "Exercise Increasers" (Low-->High; N = 27), "Exercise Decreasers" (High-->Low; N = 73), and "Exercisers" (High-->High; N = 378). The primary dependent variable was change in HAQ-DI score (scored 0-3) from 1984 to 2000. Multivariate statistical adjustments using analysis of covariance included age, gender, and changes in three risk factors, body mass index, smoking status, and number of comorbid conditions. Participants also prospectively provided reasons for exercise changes.At baseline, Sedentary and Increasers averaged little exercise (16 and 22 exercise min/wk), whereas Exercisers and Decreasers averaged over 10 times more (285 and 212 exercise min/wk; p <.001). All groups had low initial HAQ-DI scores, ranging from 0.03 to 0.08. Increasers and Exercisers achieved the smallest increments in HAQ-DI score (0.17 and 0.11) over 16 years, whereas Decreasers and Sedentary fared more poorly (increments 0.27 and 0.37). Changes in HAQ-DI score for Increasers compared to Sedentary were significantly more favorable (p <.05) even after multivariate statistical adjustment.Inactive participants who increased exercise achieved excellent end-of-study values with increments in disability similar to those participants who were more active throughout. These results suggest a beneficial effect of exercise, even when begun later in life, on postponement of disability.

    View details for Web of Science ID 000235226500012

    View details for PubMedID 16456200

  • Frailty, heart disease, and stroke - The compression of morbidity paradigm AMERICAN JOURNAL OF PREVENTIVE MEDICINE Fries, J. F. 2005; 29 (5): 164-168

    Abstract

    Frailty, the loss of physiologic organ reserve with age, and chronic illness, such as heart disease and stroke, which may accelerate the development of frailty, become the dominant determinants of ill-health in those who escape the hazards of early and mid-life. The Compression of Morbidity paradigm holds that if the average age at first chronic infirmity is postponed, and if this postponement is greater than increases in life expectancy, then average cumulative lifetime morbidity will decrease, squeezed between a later onset and the time of death. The National Long-Term Care Survey, National Health Interview Survey, and other data document declining U.S. disability trends since 1982; accelerating recently, at about 2% per year. The decline in mortality is only 1% a year, documenting Compression of Morbidity in the U.S. population. Frailty, increasing exponentially because of linear declines in multiple organ systems, mandates converging morbidity and mortality rates as longevity increases. Longitudinal studies now link good health risk status with reduced lifetime disability; those with few health risks have only one-fourth the disability of those who have more risks, and the onset of disability is postponed from 7 to 12 years. Randomized controlled trials of senior health enhancement programs have shown reduction in health risks, improved health status, and decreased medical costs. Current health enhancement opportunities can increase health gains for seniors under the umbrella paradigm of the Compression of Morbidity. Effective interventions to prevent or postpone heart disease and stroke will decrease lifetime morbidity.

    View details for DOI 10.1016/j.amepre.2005.07.004

    View details for Web of Science ID 000234400900027

    View details for PubMedID 16389144

  • The Health Assessment Questionnaire (HAQ) CLINICAL AND EXPERIMENTAL RHEUMATOLOGY Bruce, B., Fries, J. F. 2005; 23 (5): S14-S18

    Abstract

    Patient-reported outcomes (PROs) provide intrinsic knowledge about a patient's health, functional status, symptoms, treatment preferences, satisfaction, and quality of life. They have become an established approach for assessing health outcomes. The Health Assessment Questionnaire (HAQ), introduced in 1980, is among the first PRO instruments designed to represent a model of patient-oriented outcome assessment. The HAQ is based on five patient-centered dimensions: disability, pain, medication effects, costs of care, and mortality. It has been validated by mail, in the office, by telephone, and by comparison with paraprofessional and physician judgments as a reliable instrument, and has been significantly correlated with other PRO instruments. Typically, one of two HAQ versions is used: the Full HAQ, which assesses all five dimensions, and the Short or 2-page HAQ, which contains only the HAQ disability index (HAQ-DI) and the HAQ's patient global and pain visual analog scales (VAS). The HAQ-DI and the global and pain VAS (i.e., the short HAQ) have essentially retained their original content since their inception, while the Full HAQ undergoes periodic revision to address issues of contemporary scientific interest. The HAQ-DI has been translated or culturally adapted into more than 60 different languages or dialects and has become part of the National Institutes of Health "Road-map" Project, the Patient-Reported Outcomes Measurement Information System (PROMIS).

    View details for Web of Science ID 000233017500003

    View details for PubMedID 16273780

  • The promise of PROMIS: Using item response theory to improve assessment of patient-reported outcomes CLINICAL AND EXPERIMENTAL RHEUMATOLOGY Fries, J. F., Bruce, B., Cella, D. 2005; 23 (5): S53-S57

    Abstract

    PROMIS (Patient-Reported-Outcomes Measurement Information System) is an NIH Roadmap network project intended to improve the reliability, validity, and precision of PROs and to provide definitive new instruments that will exceed the capabilities of classic instruments and enable improved outcome measurement for clinical research across all NIH institutes. Item response theory (IRT) measurement models now permit us to transition conventional health status assessment into an era of item banking and computerized adaptive testing (CAT). Item banking uses IRT measurement models and methods to develop item banks from large pools of items from many available questionnaires. IRT allows the reduction and improvement of items and assembles domains of items which are unidimensional and not excessively redundant. CAT provides a model-driven algorithm and software to iteratively select the most informative remaining item in a domain until a desired degree of precision is obtained. Through these approaches the number of patients required for a clinical trial may be reduced while holding statistical power constant. PROMIS tools, expected to improve precision and enable assessment at the individual patient level which should broaden the appeal of PROs, will begin to be available to the general medical community in 2008.

    View details for Web of Science ID 000233017500008

    View details for PubMedID 16273785

  • Antigen microarray profiling of autoantibodies in rheumatoid arthritis ARTHRITIS AND RHEUMATISM Hueber, W., Kidd, B. A., Tomooka, B. H., Lee, B. J., Bruce, B., Fries, J. F., Sonderstrup, G., Monach, P., Drijfhout, J. W., van Venrooij, W. J., Utz, P. J., Genovese, M. C., Robinson, W. H. 2005; 52 (9): 2645-2655

    Abstract

    Because rheumatoid arthritis (RA) is a heterogeneous autoimmune disease in terms of disease manifestations, clinical outcomes, and therapeutic responses, we developed and applied a novel antigen microarray technology to identify distinct serum antibody profiles in patients with RA.Synovial proteome microarrays, containing 225 peptides and proteins that represent candidate and control antigens, were developed. These arrays were used to profile autoantibodies in randomly selected sera from 2 different cohorts of patients: the Stanford Arthritis Center inception cohort, comprising 18 patients with established RA and 38 controls, and the Arthritis, Rheumatism, and Aging Medical Information System cohort, comprising 58 patients with a clinical diagnosis of RA of <6 months duration. Data were analyzed using the significance analysis of microarrays algorithm, the prediction analysis of microarrays algorithm, and Cluster software.Antigen microarrays demonstrated that autoreactive B cell responses targeting citrullinated epitopes were present in a subset of patients with early RA with features predictive of the development of severe RA. In contrast, autoimmune targeting of the native epitopes contained on synovial arrays, including several human cartilage gp39 peptides and type II collagen, were associated with features predictive of less severe RA.Proteomic analysis of autoantibody reactivities provides diagnostic information and allows stratification of patients with early RA into clinically relevant disease subsets.

    View details for DOI 10.1002/art.21269

    View details for Web of Science ID 000232115700009

    View details for PubMedID 16142722

  • The arthritis, rheumatism and aging medical information system (ARAMIS): Still young at 30 years CLINICAL AND EXPERIMENTAL RHEUMATOLOGY Bruce, B., Fries, J. F. 2005; 23 (5): S163-S167

    Abstract

    Chronic diseases such as atherosclerosis, arthritis, diabetes, and cancer are among major public health concerns. To understand their cumulative risk factors and antecedents, a chronic disease databank consisting of time-oriented, multidisciplinary longitudinal data, prospectively collected on consecutive patients and describing their clinical courses, provides a systematic anthology of patient reported outcome (PRO) data. ARAMIS, which began in the mid-1970s, was the first large-scale chronic disease data bank system. Outcomes data are collected using the Health Assessment Questionnaire (HAQ), a well established PRO instrument that collects patient-centered data in the areas of disability, pain and other symptoms, adverse effects of treatment, economic impact, and mortality. More than 900 peer-reviewed studies have emanated from ARAMIS since its inception. In the earlier days, and even today, ARAMIS had to invent its own tools for the study of these new sciences. ARAMIS has made dominant contributions to the understanding of PROs and to helping improve treatment and health outcomes in rheumatoid arthritis (RA), osteoarthritis (OA), scleroderma, lupus, aging, and drug side effects. It continues to traverse terrain with participation in the NIH "Roadmap" project, the Patient Reported Outcome Measurement Information System (PROMIS). PROMIS is designed to provide improved assessment of health status across all chronic illnesses as part of an improved infrastructure for clinical research. As initiator of the rich history of chronic disease data banks with "rolling" consecutive open patient cohorts, ARAMIS has enabled the study of real-world PROs in rheumatology, with a wealth of resultant improved approaches to treatment, outcome, cost effectiveness, and quality of life.

    View details for Web of Science ID 000233017500024

    View details for PubMedID 16273801

  • Framing health messages based on anomalies in time preference MEDICAL SCIENCE MONITOR Ortendahl, M., Fries, J. F. 2005; 11 (8): RA253-RA256

    Abstract

    Time discounting processes and their effects are increasingly taken into account in health-related decisions. Because these effects have a potentially large impact the characteristics of discounting should also be taken into consideration when framing health messages. Research on the relationship between time and health is discussed with a special focus on discounting biases. The criteria for selection of articles were potential practical application when formulating health messages. Time discounting processes vary with individuals and contexts. Therefore, no single model is expected to describe discounting processes completely. Discounting biases appear more prevalent in health decisions than in economic decisions, even when health and monetary outcomes are matched for utility. Research on decision-making under conditions of uncertainty has documented numerous anomalies of expected utility. Analysis on the anomalies related to intertemporal choice and discounted utility (DU) include the magnitude effect, dynamic inconsistency effect, instant endowment, status quo bias, and sequence effect. Discounting biases in the formulation of preventive health messages are important. The desire for behavioral change in these programs would benefit from considering the psychological factor of discounting. Framing health messages in terms of large, important outcomes or long delays should induce lower implicit discount rates. Framing health messages as losses rather than gains, or as involving a series of outcomes rather than individual outcomes, might similarly lower the implicit discount rate used.

    View details for Web of Science ID 000231597900022

    View details for PubMedID 16049392

  • Cardiovascular risk profile earlier in life and medicare costs in the last year of life ARCHIVES OF INTERNAL MEDICINE Daviglus, M. L., Liu, K., Pirzada, A., Yan, L. L., Garside, D. B., Greenland, P., Manheim, L. M., Dyer, A. R., Wang, R. W., Lubitz, J., Manning, W. G., Fries, J. F., Stamler, J. 2005; 165 (9): 1028-1034

    Abstract

    Health care costs are generally highest in the year before death, and much attention has been directed toward reducing costs for end-of-life care. However, it is unknown whether cardiovascular risk profile earlier in life influences health care costs in the last year of life. This study addresses this question.Prospective cohort of adults from the Chicago Heart Association Detection Project in Industry included 6582 participants (40% women), aged 33 to 64 years at baseline examination (1967-1973), who died at ages 66 to 99 years. Medicare billing records (1984-2002) were used to obtain cardiovascular disease-related and total charges (adjusted to year 2002 dollars) for inpatient and outpatient services during the last year of life. Participants were classified as having favorable levels of all major cardiovascular risk factors (low risk), that is, serum cholesterol level lower than 200 mg/dL (<5.2 mmol/L), blood pressure 120/80 mm Hg or lower and no antihypertensive medication, body mass index (calculated as weight in kilograms divided by the square of height in meters) lower than 25, no current smoking, no diabetes, and no electrocardiographic abnormalities, or unfavorable levels of any 1 only, any 2 only, any 3 only, or 4 or more of these risk factors.In the last year of life, average Medicare charges were lowest for low-risk persons. For example, cardiovascular disease-related and total charges were lower by 10,367 dollars and 15,318 dollars compared with those with 4 or more unfavorable risk factors; the fewer the unfavorable risk factors, the lower the Medicare charges (P for trends <.001). Analyses by sex showed similar patterns.Favorable cardiovascular risk profile earlier in life is associated with lower Medicare charges at the end of life.

    View details for Web of Science ID 000229001400009

    View details for PubMedID 15883242

  • Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study ARTHRITIS RESEARCH & THERAPY Bruce, B., Fries, J. F., Lubeck, D. P. 2005; 7 (6): R1263-R1270

    Abstract

    We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years. We conducted a prospective, longitudinal study in 866 Runners' Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running. Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners' Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations. Runner's Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners' Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners. Exercise was associated with significantly lower pain scores over time in the Runners' Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners. Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.

    View details for Web of Science ID 000234272000020

    View details for PubMedID 16277679

  • Longitudinal comparison of the Health Assessment Questionnaire (HAQ) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH Bruce, B., Fries, J. 2004; 51 (5): 730-737

    Abstract

    To compare the measurement properties of the generic Health Assessment Questionnaire (HAQ) and the disease-specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Physical function, pain, and radiographic progression were assessed in knee or hip osteoarthritis patients (n = 271) who had 2 radiographs that were at least 6 months apart from 6 ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) databanks. Data were compared at baseline and after a mean of 3.2 (SE 0.10) years. Correlation coefficients and standardized effect sizes (SES) were used to assess their relationship and responsiveness.The majority of items in the 2 function and pain scales overlapped and were highly and significantly correlated with each other at baseline and last assessments (function at baseline rs = 0.71 and function at last assessment rs = 0.79, P < 0.0001; pain at baseline rs = 0.70 and pain at last assessment rs = 0.76, P < 0.0001). The HAQ disability index and total knee score were more sensitive to detection of disease progression than the WOMAC (SES for HAQ = 0.27; SES for WOMAC = -0.05).Both instruments showed favorable measurement properties, with the HAQ having the advantages of being more sensitive to change and adaptable to a wide variety of diseases and conditions, which contribute to the generalizability of findings.

    View details for Web of Science ID 000224502600007

    View details for PubMedID 15478152

  • New instruments for assessing disability: Not quite ready for prime time ARTHRITIS AND RHEUMATISM Fries, J. F. 2004; 50 (10): 3064-3067

    View details for DOI 10.1002/art.20550

    View details for Web of Science ID 000224508400002

    View details for PubMedID 15476230

  • The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis ARTHRITIS AND RHEUMATISM Fries, J. F., Murtagh, K. N., Bennett, M., Zatarain, E., Lingala, B., Bruce, B. 2004; 50 (8): 2433-2440

    Abstract

    Nonsteroidal antiinflammatory drug (NSAID)-associated gastropathy is a major cause of hospitalization and death. This study was undertaken to examine whether recent preventive approaches have been associated with a declining incidence of NSAID gastropathy, and, if so, what measures may have caused the decline.We studied 5,598 patients with rheumatoid arthritis (RA) over 31,262 patient-years at 8 sites. We obtained standardized longitudinal information on the patients that had been previously used to establish the incidence of NSAID gastropathy, and also information on patient risk factors and differences in toxicity between NSAIDs. Consecutive patients were followed up with biannual Health Assessment Questionnaires and medical record audits between 1981 and 2000. The major outcome measure was the annual rate of hospitalization involving bleeding, obstruction, or perforation of the gastrointestinal (GI) tract and related conditions.Rates of GI-related hospitalizations rose from 0.6% in 1981 to 1.5% in 1992 (P < 0.001), and then declined to 0.5% in 2000 (P < 0.001). The fitted spline curve fit the data well (R2 = 0.70). The period of rise was mainly associated with increasing patient age and the GI risk propensity score. The period of decline was associated with lower doses of ibuprofen and aspirin, a decline in the use of "more toxic" NSAIDs from 52% to 42% of patients, a rise in the use of "safer" NSAIDs from 19% to 48% of patients, and increasing use of proton-pump inhibitors, but not with change in age, NSAID exposure, or GI risk propensity score.The risk of serious NSAID gastropathy has declined by 67% in these cohorts since 1992. We estimate that 24% of this decline was the result of lower doses of NSAIDs, while 18% was associated with the use of proton-pump inhibitors and 14% with the use of less toxic NSAIDs. These declines in the incidence of NSAID gastropathy are likely to continue.

    View details for DOI 10.1002/art.20440

    View details for Web of Science ID 000223185500008

    View details for PubMedID 15334455

  • Attrition bias in rheumatoid arthritis databanks: A case study of 6346 patients in 11 databanks and 65,649 administrations of the health assessment questionnaire JOURNAL OF RHEUMATOLOGY Krishnan, E., Murtagh, K., Bruce, B., Cline, D., Singh, G., Fries, J. F. 2004; 31 (7): 1320-1326

    Abstract

    Patient dropout (attrition) can bias and threaten validity of databank-based studies. Although there are several databanks of rheumatoid arthritis (RA) in operation, this phenomenon has not been well studied.We studied the attrition patterns of patients with RA in 11 long-running databanks where patients were followed using semiannual Health Assessment Questionnaires. Attrition rates were calculated as the proportion of living patients who were in active followup at the cutoff date. Mantel-Haenszel methods and Weibull regression were used to model the relationship between attrition and age, sex, race, education, disease duration, functional disability, and other characteristics.Overall, 6346 patients with RA were recruited into the study cohorts and followed for 32,823 person-years with 65,649 observations. The crude attrition rate was 3.8% per cycle. Rates were lowest in community-based databanks. Smaller size of the centers, inner-city location, and university clinic settings were associated with worse attrition. In multivariable analyses, younger age, lower levels of education, and non-Caucasian race predicted attrition. Level of disability and disease duration were not associated with attrition. Conclusion. In terms of person-years of followup and observation-points, this may be the largest study on attrition to date. While it is possible to have very high overall retention rates, certain types of databanks (smaller, inner-city-based, and university-based) are more likely to be biased due to selective retention of older, more educated Caucasian patients.

    View details for Web of Science ID 000222481600015

    View details for PubMedID 15229950

  • Incorporating disability into population-level models of health change at older ages - Commentary JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Fries, J. F. 2004; 59 (6): 603-605
  • Robine and Michel's "Looking forward to a general theory on population aging": commentary. journals of gerontology. Series A, Biological sciences and medical sciences Fries, J. F. 2004; 59 (6): M603-5

    View details for PubMedID 15215275

  • Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions MEDICAL CARE Lorig, K. R., Ritter, P. L., Laurent, D. D., Fries, J. F. 2004; 42 (4): 346-354

    Abstract

    The objective of this study was to test the effectiveness of a mail-delivered, tailored self-management intervention (SMART) and to compare it with the classic Arthritis Self-Management Program (ASMP).We performed 2 randomized controlled trials: 1) a study of 1090 participants randomized to SMART or USUAL CARE, and 2) a study of 341 participants randomized to SMART or ASMP. Dependent variables included disability, pain, depression, role function, global severity, doctor visits, and self-efficacy. SMART interventions were provided in months 0-18 and not reinforced. Results were assessed at 1, 2, and 3 years using analyses of covariance (ANCOVA).Compared with USUAL CARE, SMART participants at 1 year had decreased disability, improved role function, and increased self-efficacy (all P <0.01). At 2 years, decreases in global severity, doctor visits, and increases in self-efficacy (all P <0.01) were noted. At 3 years without reinforcement, no statistically significant effects remained. Compared with ASMP, SMART at 1 year had greater decreases in disability (P = 0.02) and increases in self-efficacy (P = 0.01). There were no differences at 2 years. At 3 years, role function (P = 0.04) and doctor visit (P = 0.03) were improved in ASMP as compared with SMART. Improvements from baseline were seen for nearly all variables in both groups.A mail-delivered arthritis self-management program, SMART, was similarly effective to the classic ASMP, with slightly better results in the first year and a slightly more rapid attenuation over the next 2 years. Results suggest that both programs are effective, and that the addition of a mail-delivered program could improve accessibility to arthritis self-management treatment.

    View details for DOI 10.1097/07.mlr.0000118709.74348.65

    View details for Web of Science ID 000220475800007

    View details for PubMedID 15076811

  • Percentile benchmarks in patients with rheumatoid arthritis: Health Assessment Questionnaire as a quality indicator (QI) ARTHRITIS RESEARCH & THERAPY Krishnan, E., Tugwell, P., Fries, J. F. 2004; 6 (6): R505-R513

    Abstract

    Physicians are in need of a simple objective, standardized tool to compare their patients with rheumatoid arthritis, as a group and individually, with national standards. The Disability Index of the Health Assessment Questionnaire (HAQ-DI) is a simple, robust tool that can fulfill these needs. However, use of this tool as a quality indicator (QI) is hampered by the unavailability of national reference values or benchmarks based on large, multicentric, heterogenous longitudinal patient cohorts. We utilized the 20-year longitudinal prospective data from 11 data banks of Arthritis Rheumatism and Aging Medical Information to calculate reference values for HAQ-DI. Overall, 6436 patients with rheumatoid arthritis were longitudinally followed for 32,324 person-years over the 20 years from 1981 to 2000. There were 64,647 HAQ-DI measurements, with an average of 19 measurements per person. Overall, 75% of patients were women and 89% were Caucasian; the median baseline age was 58.4 years and the median baseline HAQ-DI was 1.13. Few patients were treated with biologics. The HAQ-DI values had a Gaussian distribution except for the approximately 10% of observations showing no disability. Percentile benchmarks allow disability outcomes to be compared and contrasted between different patient populations. Reference values for the HAQ-DI, presented here numerically and graphically, can be used in clinical practice as a QI measure to track functional disability outcomes and to measure response to therapy, and by arthritis patients in self-management programs.

    View details for DOI 10.1186/ar1220

    View details for Web of Science ID 000225160100008

    View details for PubMedID 15535828

  • Measuring effectiveness of drugs in observational databanks: promises and perils ARTHRITIS RESEARCH & THERAPY Krishnan, E., Fries, J. F. 2004; 6 (2): 41-44

    Abstract

    Observational databanks have inherent strengths and shortcomings. As in randomized controlled trials, poor design of these databanks can either exaggerate or reduce estimates of drug effectiveness and can limit generalizability. This commentary highlights selected aspects of study design, data collection and statistical analysis that can help overcome many of these inadequacies. An international metaRegister and a formal mechanism for standardizing and sharing drug data could help improve the utility of databanks. Medical journals have a vital role in enforcing a quality checklist that improves reporting.

    View details for DOI 10.1186/ar1151

    View details for Web of Science ID 000189035200001

    View details for PubMedID 15059263

  • Equipoise, design bias, and randomized controlled trials: the elusive ethics of new drug development ARTHRITIS RESEARCH & THERAPY Fries, J. F., Krishnan, E. 2004; 6 (3): R250-R255

    Abstract

    The concept of 'equipoise', or the 'uncertainty principle', has been represented as a central ethical principle, and holds that a subject may be enrolled in a randomized controlled trial (RCT) only if there is true uncertainty about which of the trial arms is most likely to benefit the patient. We sought to estimate the frequency with which equipoise conditions were met in industry-sponsored RCTs in rheumatology, to explore the reasons for any deviations from equipoise, to examine the concept of 'design bias', and to consider alternative ethical formulations that might improve subject safety and autonomy. We studied abstracts accepted for the 2001 American College of Rheumatology meetings that reported RCTs, acknowledged industry sponsorship, and had clinical end-points (n = 45), and examined the proportion of studies that favored the registration or marketing of the sponsor's drug. In every trial (45/45) results were favorable to the sponsor, indicating that results could have been predicted in advance solely by knowledge of sponsorship (P < 0.0001). Equipoise clearly was being systematically violated. Publication bias appeared to be an incomplete explanation for this dramatic result; this bias occurs after a study is completed. Rather, we hypothesize that 'design bias', in which extensive preliminary data are used to design studies with a high likelihood of being positive, is the major cause of the asymmetric results. Design 'bias' occurs before the trial is begun and is inconsistent with the equipoise principle. However, design bias increases scientific efficiency, decreases drug development costs, and limits the number of subjects required, probably reducing aggregate risks to participants. Conceptual and ethical issues were found with the equipoise principle, which encourages performance of negative studies; ignores patient values, patient autonomy, and social benefits; is applied at a conceptually inappropriate decision point (after randomization rather than before); and is in conflict with the Belmont, Nuremberg, and other sets of ethical principles, as well as with US Food and Drug Administration procedures. We propose a principle of 'positive expected outcomes', which informs the assessment that a trial is ethical, together with a restatement of the priority of personal autonomy.

    View details for DOI 10.1186/ar1170

    View details for Web of Science ID 000222512700015

    View details for PubMedID 15142271

  • Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: A longitudinal study of 3035 patients AMERICAN JOURNAL OF MEDICINE Krishnan, E., Fries, J. F. 2003; 115 (5): 371-376

    Abstract

    If newer, more aggressive treatment strategies in rheumatoid arthritis are more effective, long-term outcomes in rheumatoid arthritis should be improving substantially. We therefore assessed trends in disability over time in a large cohort of patients with rheumatoid arthritis.We examined functional disability data from 3035 patients with rheumatoid arthritis whose disease onset was from 1977 to 1998. Disability data were collected semiannually with the Health Assessment Questionnaire disability index. We then estimated average disability for each patient. We also computed mean disability for each calendar year by averaging the values from all patients in that year. We examined the relation of successive annual cohorts and subsequent disability, adjusting for age, sex, race, education, clinical center, disease duration, follow-up, and attrition. We used two regression approaches: ordinary and generalized least squares.Average disability declined by about 2% to 3% per calendar year of disease onset (2.7% to 2.8% per year [P <0.001] in univariable models and 2.0% to 2.1% per year [P <0.001] in multivariable models). This trend was consistent by age, sex, race, disease duration, clinical center, and baseline disability.After accounting for potential confounders, average disability levels in rheumatoid arthritis have declined by approximately 40% in the 20+ years since 1977. This decline is consistent with a beneficial effect of the associated changes in treatment strategies.

    View details for DOI 10.1016/S0002-9343(03)00397-8

    View details for Web of Science ID 000185776400005

    View details for PubMedID 14553872

  • Rates of serious gastrointestinal events from low dose use of acetylsalicylic acid, acetaminophen, and ibuprofen in patients with osteoarthritis and rheumatoid arthritis JOURNAL OF RHEUMATOLOGY Fries, J. F., Bruce, B. 2003; 30 (10): 2226-2233

    Abstract

    The frequency of serious gastrointestinal (GI) complications has been quantitated with chronic high doses of nonsteroidal antiinflammatory drugs (NSAID), but risk at lower dosages remains unknown. We examined the prevalence of serious GI events in patients taking aspirin (ASA), acetaminophen (APAP), or ibuprofen (IBU), focusing on low or intermittent use.We studied 5692 patients with rheumatoid arthritis (RA) and 3124 patients with osteoarthritis (OA) from 12 databank centers, with 36,262 patient-years of observation, who had taken one of 3 study analgesics, and examined the frequency of serious GI events requiring hospitalization.Treatment groups were of similar ages and severity. As lower doses of study analgesics were taken, serious GI events tended to be less prevalent. In patients taking a study drug alone, without other analgesics or corticosteroids, only one event occurred in over 900 patient-years of exposure, roughly equivalent to background. Rates of GI events while taking APAP with other concurrent therapy or corticosteroids were higher (p < 0.05) than for the other 2 analgesics. In over-the-counter (OTC) doses, there were no significant differences in GI toxicity among analgesics. RA patients tended to have higher rates than OA patients. The rate of GI events was highly dependent on concurrent therapy, increasing 2 to 6-fold in patients taking other analgesics or corticosteroids. Propensity scores for serious GI events were similar across drugs.OTC use of ASA, IBU, or APAP carries little risk of serious GI toxicity for most persons. Most serious problems encountered were in higher-risk patients. Given the low rates of events, at low or intermittent dosage without concurrent treatment, these 3 analgesics cannot be distinguished from each other or from background rates of serious GI toxicity.

    View details for Web of Science ID 000185711700025

    View details for PubMedID 14528521

  • Measuring and monitoring success in compressing morbidity ANNALS OF INTERNAL MEDICINE Fries, J. F. 2003; 139 (5): 455-459

    Abstract

    The Compression of Morbidity paradigm, introduced in 1980, maintains that if the average age at first infirmity, disability, or other morbidity is postponed and if this postponement is greater than increases in life expectancy, then cumulative lifetime morbidity will decrease-compressed between a later onset and the time of death. The National Long-Term Care Survey, the National Health Interview Survey, and other data now document declining disability trends beginning in 1982 and accelerating more recently. The decline is about 2% per year, contrasted with a decline in mortality rates of about 1% per year, thereby documenting compression of morbidity in the United States at the population level. Longitudinal studies now link good health risk status with long-term reductions in cumulative lifetime disability; persons with few behavioral health risks have only one-fourth the disability of those who have more risk factors, and the onset of disability is postponed from 7 to 12 years, far more than any increases in longevity in the groups. Randomized, controlled trials of health enhancement programs in elderly populations show reduction in health risks, improved health status, and decreased medical care utilization. Health policy initiatives now being undertaken have promise of increasing and consolidating health gains for the elderly.

    View details for Web of Science ID 000185133800015

    View details for PubMedID 12965976

  • Patient self-management arthritis? Yes! JOURNAL OF RHEUMATOLOGY Fries, J. F., Lorig, K., Holman, H. R. 2003; 30 (6): 1130-1132

    View details for Web of Science ID 000183356700002

    View details for PubMedID 12784379

  • Reduction in long-term functional disability in Rheumatoid Arthritis 1977-1998: longitudinal study of 3035 patients. Am J Med Krishnan E, Fries JF 2003; 115 (5): 371-376
  • The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health and quality of life outcomes Bruce, B., Fries, J. F. 2003; 1: 20-?

    Abstract

    The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.

    View details for PubMedID 12831398

  • The Stanford Health Assessment Questionnaire: A review of its history, issues, progress, and documentation JOURNAL OF RHEUMATOLOGY Bruce, B., Fries, J. F. 2003; 30 (1): 167-178

    Abstract

    Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.

    View details for Web of Science ID 000180285600028

    View details for PubMedID 12508408

  • Reducing disability in older age JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Fries, J. F. 2002; 288 (24): 3164-3166

    View details for Web of Science ID 000180008200029

    View details for PubMedID 12495399

  • Postponed development of disability in elderly runners - A 13-year longitudinal study ARCHIVES OF INTERNAL MEDICINE Wang, B. W., Ramey, D. R., Schettler, J. D., Hubert, H. B., Fries, J. F. 2002; 162 (20): 2285-2294

    Abstract

    The magnitude and duration of the benefit of running and other aerobic exercise on disability and mortality in elderly persons are not well understood. We sought to quantify the benefits of aerobic exercise, including running, on disability and mortality in elderly persons and to examine whether morbidity can be compressed into later years of life by regular exercise.A 13-year prospective cohort study of 370 members of a runners' club for persons aged 50 and older and 249 control subjects initially aged 50 to 72 years (mean, 59 years), with annual ascertainment of the Health Assessment Questionnaire disability score, noting any deaths and their causes. Linear mixed models were used to compute postponement in disability, and survival analysis was conducted to determine the time to and causes of death.Significantly (P<.001) lower disability levels in runners' club members vs controls and in ever runners vs never runners were sustained for at least 13 years. Reaching a Health Assessment Questionnaire disability level of 0.075 was postponed by 8.7 (95% confidence interval [CI], 5.5-13.7) years in runners' club members vs controls. Running club membership and participation in other aerobic exercise protected against mortality (rate ratio, 0.36 [95% CI, 0.20-0.65] and 0.88 [95% CI, 0.77-0.99], respectively), while male sex and smoking were detrimental (rate ratio, 2.4 [95% CI, 1.4-4.2] and 2.2 [95% CI, 1.1-4.6], respectively). Controls had a 3.3 times higher rate of death than runners' club members, with higher death rates in every disease category. Accelerated rates of disability and mortality were still not seen in the runners' club members; true compression of morbidity was not yet observable through an average age of 72 years.Running and other aerobic exercise in elderly persons protect against disability and early mortality, and are associated with prolongation of a disability-free life.

    View details for Web of Science ID 000179148300003

    View details for PubMedID 12418943

  • The methotrexate therapeutic response in rheumatoid arthritis JOURNAL OF RHEUMATOLOGY Ortendahl, M., Holmes, T., Schettler, J. D., Fries, J. F. 2002; 29 (10): 2084-2091

    Abstract

    Methotrexate (MTX) is used frequently as a disease modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA), and patients tend to continue taking this drug for longer periods than alternative single agents. The shape of the therapeutic response beyond one or 2 years, however, has not been fully studied. We examined the properties of the pure MTX "therapeutic segment," that period that begins with start of MTX and terminates when MTX is discontinued or another DMARD is added, by observational study.We studied new MTX starts for the period 1988 through 1996 for 437 patients from a parent cohort of 4253 patients. Patients were drawn from 8 Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) data centers: 2 community based populations; 2 private rheumatological practices; 2 university referral practices; and 2 university clinics for underserved minority urban populations. Health Assessment Questionnaire (HAQ) Disability Index scores (0-3) were obtained prospectively each 6 months.At MTX start, patients had relatively long average disease duration of 16.7 years, and had moderately severe disability, with an initial HAQ mean disability score of 1.48. Over the 10 year period examined in the parent cohort of 4253 patients (and thus irrespective of therapy), the prevalence of MTX use rose from 19% to 45%, while mean HAQ disability declined from 1.34 to 1.11. This correspondence is consistent with an accrual of benefits from more frequent use of MTX and other DMARD over this period. The MTX therapeutic segment revealed a distinct shape. HAQ-Disability Index values began at 1.48 at baseline and declined to a maximal improvement of 1.23 at 30 months. This long period to maximum benefit may have been partly driven by a slow titration upward to an optimal dosage. After 42 months, disability for this population began to re-progress and reached 1.39 at 84 months, still below the pretreatment baseline. Re-progression to baseline was about 8 or more years. Cumulative disability averted with MTX treatment for this population was roughly 1.30 disability-unit-years.MTX treatment of RA in practice differs substantially from common perception and appears suboptimal by being too little, too late, and too long to treatment change. A modification of the "sawtooth strategy" in which the disease is "ratcheted down" by change of MTX therapy at 3 years or when re-progression has proceeded halfway to baseline, rather than waiting for return to baseline, is suggested by these data. Also suggested is the need for more rapid upward dosage titration and longer maintenance of an optimal or highest tolerated dosage. "Therapeutic segment" data provide insights into strategic approaches to management of RA since they allow estimation of population aggregate properties such as time to maximum benefit and the time to return to baseline.

    View details for Web of Science ID 000178374000011

    View details for PubMedID 12375316

  • Time-related issues with application to health gains and losses JOURNAL OF CLINICAL EPIDEMIOLOGY Ortendahl, M., Fries, J. F. 2002; 55 (9): 843-848

    Abstract

    Time-related aspects of health have attracted increasing interest, and it has become evident that many medical situations concern the exchange of present-day costs for future benefits. Traditional decision analytic paradigms weigh the probability of outcomes and the value of outcomes. Such analyses are incomplete if they do not consider the time of the outcome as well. The concept of diminishing value over time is positive discounting. Time discounting processes and effects have a potentially large impact on clinical decision making. Therefore, characteristics of discounting should be taken into consideration. Discounting processes are variable with individuals and also within different contexts such as gains and losses. No single model can be expected to describe time-related decisions within health. A more diversified use and critical appraisal of these concepts in medicine become more important as we attempt to refine decision models. A summary of valuation factors in medical decision making is presented: (a) long-term decisions are very sensitive to discount rates; (b) discount rates are greater for gains than for losses; (c) discount rates vary by domain, by outcome, by individuals over time, and by level of certainty; (d) individual preferences may reverse themselves over time; (e) the doctor uses expected value; the patient is risk aversive; (f) over a lifetime perspective, a flat or even negative discount rate will result in choices that minimize lifetime disability.

    View details for Web of Science ID 000178375000001

    View details for PubMedID 12393070

  • HLA-DRB1 genotype associations in 793 white patients from a rheumatoid arthritis inception cohort - Frequency, severity, and treatment bias ARTHRITIS AND RHEUMATISM Fries, J. F., Wolfe, F., Apple, R., Erlich, H., Bugawan, T., Holmes, T., Bruce, B. 2002; 46 (9): 2320-2329

    Abstract

    The HLA-DRB1 "shared epitope" (SE) genotypes are associated with rheumatoid arthritis (RA), but it remains controversial whether the association is with incidence, severity, or both, whether there are associations in seronegative patients, and whether different DRB1 alleles that contain the SE have similar effects on RA susceptibility and/or severity. The present study was undertaken to study these issues in a large cohort of patients with RA.White patients with RA of <6 months' duration (n = 793) were enrolled in an inception cohort. HLA-DRB1 typing was performed, and patients were categorized into 21 DRB1 genotype groups. The disability index of the Health Assessment Questionnaire was the primary outcome measure.DRB1 associations in seronegative RA patients closely resembled those in controls. Of seropositive patients, 21% had 2 copies of the epitope, 52% had 1 copy, and 27% had none. However, not all genotypes with 1 copy were associated with increased susceptibility; for example, frequencies of DRB1*0404/X and *01/X did not differ from those in controls. Absolute differences between seropositive RA patients and controls were greatest for DRB1*0401 homozygosity (3.8% versus 0.8%, respectively) and *0401/0404 heterozygosity (4.7% versus 1.0%). DRB1*0404 was increased in frequency in seropositive RA but, unlike *0401, an increased frequency was seen only with 2 epitope copies. The relatively rare DRB1*10 had an unexpected association with seropositive RA, being present in 1.7% of seropositive RA patients and 0.7% of controls, and also showed a trend toward association with greater disease severity. The presence of 2 epitope copies was associated with increased frequency of seropositivity and younger age at disease onset, not with disease severity. Treatment indication bias was substantial and may have accounted for some of these effects. HLA-DRB1*0401/0404 was found much more frequently in men and in patients with a lower age at disease onset, and there was a trend toward a higher frequency of *0404/0401 in women.This large inception cohort study confirms previously identified major associations and provides additional insights. Only one dominant association was found: *0401, which differs from other SE alleles in a single Lys-for-Arg substitution. The association of the rare DRB1*10 allele has not previously been postulated. Sex associations were confirmed. Associations with seronegative RA were not seen. Not all genotypes containing an SE copy showed increased susceptibility to RA. The association of SE genotypes found in this study related to disease susceptibility rather than severity.

    View details for DOI 10.1002/art.10485

    View details for Web of Science ID 000178421500007

    View details for PubMedID 12355479

  • Methotrexate, hydroxychloroquine, and intramuscular gold in rheumatoid arthritis: Relative area under the curve effectiveness and sequence effects JOURNAL OF RHEUMATOLOGY Hurst, S., Kallan, M. J., Wolfe, F. J., Fries, J. F., Albert, D. A. 2002; 29 (8): 1639-1645

    Abstract

    The use of disease modifying antirheumatic drugs (DMARD) for rheumatoid arthritis (RA) is predicated on the expected value of the treatment course. Most clinical data are generalized from randomized controlled trials (RCT), which may result in estimates that are discordant with clinical experience and cannot address the effects of sequence of drugs. We computed estimates of relative DMARD effectiveness from a large observational database using area under the curve (AUC) data.We examined data collected over a 20 year period on 1160 patients who were followed at the Wichita Arthritis Center. We utilized Health Assessment Questionnaire (HAQ) disability index data to quantify the effect of methotrexate (MTX), hydroxychloroquine (HCQ), and injectable gold (gold) on subsequent patient outcome. Using an AUC analysis, we compared length of treatment course, total disability averted, annual disability averted, and percentage of possible disability averted across drugs, and examined differences between first courses of therapy in DMARD naive patients and subsequent courses of the same and different DMARD in patients.Patients treated with MTX, HCQ, and gold improved at a rate of -0.33, -0.18 and -0.38 annualized HAQ area units, respectively. Since duration taking drug was greatest for MTX, then HCQ, then gold, the cumulative improvement was greatest with MTX (-1.07) versus gold (-0.74) versus HCQ (-0.47) in disability unit years. All 3 drugs were better cumulatively with earlier disease (MTX-1.74 for < 1 yr vs -0.95 for > 1 yr; HCQ -0.68 vs -0.43; gold -1.71 vs -0.49). A second trial of the same drug was far less effective than the first course. On a percentage of possible improvement basis, these drugs were nearly equal since HCQ is given to less severely affected patients.MTX is the most effective DMARD of these 3 because of the length the therapeutic segment. In terms of disability averted, none of the agents decrease disability by more than 25% of the theoretically possible improvement. We documented that effectiveness of RA treatment is a function of drug sequence, duration of disease, whether it is a first or second course, and severity of disease. None of these clinically relevant observations have emerged from clinical trials. These methodologic approaches provide important quantitative comparative data and will be useful in further assessment of the relative effectiveness of present and future DMARD.

    View details for Web of Science ID 000177207200012

    View details for PubMedID 12180722

  • Successful aging - an emerging paradigm of gerontology CLINICS IN GERIATRIC MEDICINE Fries, J. F. 2002; 18 (3): 371-?

    Abstract

    In the largely successful preventive approach to reduction in cardiovascular disease prevalence, three classic stages of investigation were used. First, an hypothesis was raised that diet and cholesterol levels were a cause of heart disease. Second, multiple longitudinal observational studies, led by the Framingham group, documented a strong association between these health risks and heart disease mortality. Finally, randomized controlled trials of cholesterol-lowering drugs established proof of causality. Our understanding of the Successful Aging phenomenon has followed the same sequence. The Compression of Morbidity hypothesis sets forth a new and promising paradigm. Multiple longitudinal and cross-sectional observational studies show strong associations consistent with the hypothesis. Finally, randomized controlled trials of healthy aging interventions prove our ability to successfully intervene in this most important of all contemporary health problems: the health of seniors [28].

    View details for Web of Science ID 000177703600002

    View details for PubMedID 12424864

  • Lifestyle habits and compression of morbidity JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Hubert, H. B., Bloch, D. A., Oehlert, J. W., Fries, J. F. 2002; 57 (6): M347-M351

    Abstract

    There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.The risk-factor-free group showed average disability scores near zero 10-12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.

    View details for Web of Science ID 000175979900007

    View details for PubMedID 12023263

  • Frailty and education in the Hispanic Health and Nutrition Examination Survey JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Leigh, J. P., Fries, J. F. 2002; 13 (1): 112-127

    Abstract

    This study tests for the presence of education-frailty correlations among 1,176 Mexican Americans, 522 Cuban Americans, and 560 Puerto Ricans, 50 years and older, in the Hispanic Health and Nutrition Examination Survey. Hispanics with the least schooling (less than 7 years) were found to have the highest frailty rates, and those with the most (more than 12 years of schooling) were found to have the lowest frailty rates. Similar, but somewhat weaker, correlations were discovered after a measure of self-efficacy was accounted for.

    View details for Web of Science ID 000173415400009

    View details for PubMedID 11836909

  • Aging, natural death, and the compression of morbidity BULLETIN OF THE WORLD HEALTH ORGANIZATION Fries, J. F. 2002; 80 (3): 245-250

    View details for Web of Science ID 000174687500011

    View details for PubMedID 11984612

  • Patient based method of assessing adverse events in clinical trials in rheumatology: the revised Stanford Toxicity Index JOURNAL OF RHEUMATOLOGY Welch, V., Singh, G., Strand, V., Fries, J., Boers, M., Ramey, D., Day, R. O., Brooks, P., Tugwell, P., Clinch, J., Kristjansson, B. 2001; 28 (5): 1188-1191

    Abstract

    We describe the progress towards developing a patient rated toxicity index that meets all of the patient-important attributes defined by the OMERACT Drug Safety Working Party. These attributes are frequency, severity, importance to patient, importance to the clinician, impact on economics, impact on activities, and integration of adverse effects with benefits. The Stanford Toxicity Index (STI) has been revised to collect all attributes with the exception of impact on activities. However, since the STI is a part of the Health Assessment Questionnaire (HAQ), impact on activities is collected by the HAQ. In particular, a new question asks patients to rate overall satisfaction, taking into consideration both benefits and adverse effects. The next step in the development of this tool is to ensure that the STI meets the OMERACT filter of truth, discrimination, and feasibility. Although truth and feasibility have been confirmed by comparisons within the ARAMIS database, discrimination needs to be assessed in clinical trials.

    View details for Web of Science ID 000168487900048

    View details for PubMedID 11361211

  • Aging, cumulative disability, and the compression of morbidity COMPREHENSIVE THERAPY Fries, J. F. 2001; 27 (4): 322-329

    Abstract

    The Compression of Morbidity paradigm emphasizes reduction in cumulative disability by postponing chronic infirmity. This article describes the model, reviews data suggesting morbidity compression over time, establishes associations between health risks and subsequent disability, and describes risk reduction interventions.

    View details for Web of Science ID 000172592300007

    View details for PubMedID 11765690

  • Osteoarthritis: New insights - Part 2: Treatment approaches ANNALS OF INTERNAL MEDICINE Felson, D. T., Lawrence, R. C., Hochberg, M. C., McAlindon, T., Dieppe, P. A., Minor, M. A., Blair, S. N., Berman, B. M., Fries, J. F., Weinberger, M., Lorig, K. R., Jacobs, J. J., Goldberg, V. 2000; 133 (9): 726-737

    Abstract

    Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.

    View details for Web of Science ID 000165075300008

    View details for PubMedID 11074906

  • Osteoarthritis: New Insights. Part 1: The Disease and Its Risk Factors ANNALS OF INTERNAL MEDICINE Felson, D. T., Lawrence, R. C., Dieppe, P. A., Hirsch, R., Helmick, C. G., Jordan, J. M., Kington, R. S., Lane, N. E., Nevitt, M. C., Zhang, Y. Q., Sowers, M., McAlindon, T., Spector, T. D., POOLE, A. R., Yanovski, S. Z., Ateshian, G., Sharma, L., Buckwalter, J. A., Brandt, K. D., Fries, J. F. 2000; 133 (8): 635-646

    Abstract

    Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.

    View details for DOI 10.7326/0003-4819-133-8-200010170-00016

    View details for Web of Science ID 000089906300020

    View details for PubMedID 11033593

  • Factors influencing length of time taking methotrexate in rheumatoid arthritis JOURNAL OF RHEUMATOLOGY Ortendahl, M., Schettler, J. D., Fries, J. F. 2000; 27 (5): 1139-1147

    Abstract

    Duration of therapy has been suggested to represent a measure of effectiveness. Life table analyses of therapy with methotrexate (MTX) in rheumatoid arthritis (RA) have indicated a longer duration than with other drugs. However, individual patients continue taking MTX for different periods of time. We assessed the influence of patient variables at treatment onset upon subsequent duration of MTX therapy.Patients with RA (n = 437) from 8 North American databank centers beginning MTX therapy after January 1, 1988, were followed prospectively. Age at onset of MTX treatment, sex, years of education, age at onset of disease, years with disease, number of comorbid conditions, number of disease modifying antirheumatic drugs (DMARD) and nonsteroidal antiinflammatory drugs (NSAID) taken just prior to MTX. disability level, pain, and global assessment prior to starting MTX were used in univariate Kaplan-Meier analyses to predict number of months taking MTX alone. An index that divided the patients into risk strata for predicting duration of therapy was constructed to be clinically useful.The median number of months continuing MTX without addition of other DMARD was 41 months and the median for the total course taking MTX was 52 months. The retention rate was lowest for patients with the most negative initial health state. High level of initial pain, long duration of disease, and not using a DMARD just prior to MTX were associated with low retention rate and can be used to predict expected durations of MTX treatment ranging from 17 to 52 months. For practical guidance in clinical decisions an index was computed based on the predictor variables: level of initial pain, duration of disease, and number of DMARD; this index identifies subgroups with very different durations taking MTX alone. Disease duration at baseline was strongly related to time taking MTX alone and could therefore also be used as a simplified rule in clinical work.Expected duration of MTX treatment is influenced by clinical variables, and these may suggest those patients likely to have more or less satisfactory experiences with MTX. The time taking drug alone (therapeutic segment) may be a more logical and sensitive indicator of effectiveness than the total course on the medication.

    View details for Web of Science ID 000086855600009

    View details for PubMedID 10813279

  • Safety, cost and effectiveness issues with disease modifying anti-rheumatic drugs in rheumatoid arthritis ANNALS OF THE RHEUMATIC DISEASES Fries, J. F. 1999; 58: 86-89
  • Safety, cost and effectiveness issues with disease modifying anti-rheumatic drugs in rheumatoid arthritis. Annals of the rheumatic diseases Fries, J. F. 1999; 58: I86-9

    View details for PubMedID 10577980

  • Reducing need and demand for medical services in high-risk persons - A health education approach WESTERN JOURNAL OF MEDICINE Fries, J. F., McShane, D. 1998; 169 (4): 201-207

    Abstract

    We undertook this study to identify persons with high medical use to target them for health promotion and self-management interventions specific to their problems. We compared the reductions in cost and health risk of a health education program aimed at high-risk persons with a similar program addressed to all risk levels. We compared health risk and use in 2,586 high-risk persons with those of employee (N = 50,576) and senior (N = 39,076) groups and contrasted results in specific high-risk disease or behavior categories (modules)--arthritis, back pain, high blood pressure, diabetes mellitus, heart disease, smoking, and obesity--against each other, using validated self-report measures, over a 6-month period. Interventions were a standard generic health education program and a similar program directed at high risk individuals (Healthtrac). Health risk scores improved by 11% in the overall high-risk group compared with 9% in the employee group and 6% in the senior group. Physician use decreased by 0.8 visits per 6 months in the high-risk group compared with 0.05 and 0.15 visits, respectively, per 6 months in the employee and senior groups. Hospital stays decreased by 0.2 days per 6 months in the high-risk group compared with 0.05 days in the comparison groups. The duration of illness or confinement to home decreased by 0.9 days per 6 months in the high-risk group and 0.15 and 0.25, respectively, in the employee and senior groups. Using imputed costs of $130 per physician visit, $1,000 per hospital day, and $200 per sick day, previous year costs were $1,138 in direct costs for the high-risk groups compared with $352 and $995 in the employee and senior groups, respectively. At 6 months, direct costs were reduced by $304 in the high-risk group compared with $57 and $70 in the comparison groups. Total costs were reduced $484 in the high-risk groups compared with $87 in the employee group and $120 in the senior group. The return on investment was about 6:1 in the high-risk group compared with 4:1 in the comparison groups. Effective health education programs can result in larger changes in use and costs in high-risk persons than in unscreened persons, justifying more intensive educational interventions in high-risk groups.

    View details for Web of Science ID 000076401200001

    View details for PubMedID 9795579

  • The epidemiology of NSAID gastropathy - The ARAMIS experience JCR-JOURNAL OF CLINICAL RHEUMATOLOGY Fries, J. F. 1998; 4 (5): S11-S16

    Abstract

    The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) is a national database for longitudinal outcome information obtained form the long-term follow-up of patients with rheumatic disease. This database has been used to investigate the parameters associated with nonsteroidal anti-inflammatory drug (NSAID) gastropathy in a population of 2747 patients with rheumatoid arthritis (RA). Theses patients were found to have a 1.3% higher risk of hospitalization each year because of a gastrointestinal (GI) adverse event than the general population. In these patients with RA, there was a five fold higher risk of hospitalization and a twofold increase in GI mortality among NSAID users compared with the general population. Age was the most significant predictor of serious GI events in our study' disability, prednisone therapy, and previous NSAID-related GI events were also identified as risk factors. An objective index of drug toxicity was developed to facilitate comparisons of the potential risks involved with specific drug regimens. consistent toxicity scores were obtained for NSAIDs, with threefold to fourfold difference between drugs having low risk versus high risk. These studies indicate a need for changes in management practices in at-risk patients and a potential role for better tolerated NSAIDs, such as the recently developed cyclooxygenase-2 selective or preferential drugs.

    View details for Web of Science ID 000076797100003

    View details for PubMedID 19078320

  • Reducing cumulative lifetime disability: the compression of morbidity BRITISH JOURNAL OF SPORTS MEDICINE Fries, J. F. 1998; 32 (3): 193-193

    View details for Web of Science ID 000075889300004

    View details for PubMedID 9773161

  • Aging, health risks, and cumulative disability NEW ENGLAND JOURNAL OF MEDICINE Vita, A. J., Terry, R. B., Hubert, H. B., Fries, J. F. 1998; 338 (15): 1035-1041

    Abstract

    Persons with lower health risks tend to live longer than those with higher health risks, but there has been concern that greater longevity may bring with it greater disability. We performed a longitudinal study to determine whether persons with lower potentially modifiable health risks have more or less cumulative disability.We studied 1741 university alumni who were surveyed first in 1962 (average age, 43 years) and then annually starting in 1986. Strata of high, moderate, and low risk were defined on the basis of smoking, body-mass index, and exercise patterns. Cumulative disability was determined with a health-assessment questionnaire and scored on a scale of 0 to 3. Cumulative disability from 1986 to 1994 (average age in 1994, 75 years) or death was the measure of lifetime disability.Persons with high health risks in 1962 or 1986 had twice the cumulative disability of those with low health risks (disability index, 1.02 vs. 0.49; P<0.001). The results were consistent among survivors, subjects who died, men, and women and for both the last year and the last two years of observation. The onset of disability was postponed by more than five years in the low-risk group as compared with the high-risk group. The disability index for the low-risk subjects who died was half that for the high-risk subjects in the last one or two years of observation.Smoking, body-mass index, and exercise patterns in midlife and late adulthood are predictors of subsequent disability. Not only do persons with better health habits survive longer, but in such persons, disability is postponed and compressed into fewer years at the end of life.

    View details for Web of Science ID 000072969500006

    View details for PubMedID 9535669

  • Quality-of-life considerations with respect to arthritis and nonsteroidal anti-inflammatory drugs. American journal of medicine Fries, J. F. 1998; 104 (3A): 14S-20S

    Abstract

    This article first presents a hierarchical general quality-of-life framework, beginning with global "outcome" and progressing through dimensions, subdimensions, components, and finally to specific variables. Second, the Health Assessment Questionnaire (HAQ) is described as an example of a set of instruments designed to assess such a framework. A simple visual analog scale, which was incorporated into the HAQ in 1980 and which ranks the status of health from "very poor" to "very well," has been shown to correlate strongly with traditional quality-of-life instruments, such as the Torrance "Feeling Thermometer." Finally, the requirement for a side-effect index to assess quality of life related to different drug therapies is discussed. Comparative drug adverse event profiles are highlighted, a side-effect index presented, and some preliminary results and conclusions outlined. With drugs used for the treatment of rheumatic diseases, adverse events have been shown to vary widely. Indeed, the differences in side-effects are often 2-3-fold between drugs of the same class. Furthermore, the incidence of adverse events related to the use of many nonsteroidal anti-inflammatory drugs has been shown to be greater than that seen with a number of disease-modifying antirheumatic drugs.

    View details for PubMedID 9572316

  • Reducing the need and demand for medical services PSYCHOSOMATIC MEDICINE Fries, J. F. 1998; 60 (2): 140-142

    View details for Web of Science ID 000072757500002

    View details for PubMedID 9560860

  • Beyond health promotion: Reducing need and demand for medical care HEALTH AFFAIRS Fries, J. F., Koop, C. E., Sokolov, J., Beadle, C. E., Wright, D. 1998; 17 (2): 70-84

    Abstract

    A population's medical need represents its illness burden. Medical demand represents the service level requested for a particular need. Medical care costs are, in large part, a function of need and demand. Our review of health education programs designed to reduce health risks and reduce costs identified thirty-two programs with documented effectiveness, generally achieving claims reductions of 20 percent. Specific program features including chronic disease self-management, risk reduction, and increased self-efficacy appear important. A broadened definition of health promotion focused on increased personal responsibility for health-related actions and directed at improvement of long-term health outcomes also could reduce health care costs.

    View details for Web of Science ID 000072782600008

    View details for PubMedID 9558786

  • The relationship of running to osteoarthritis of the knee and hip and bone mineral density of the lumbar spine: A 9 year longitudinal study JOURNAL OF RHEUMATOLOGY Lane, N. E., Oehlert, J. W., Bloch, D. A., Fries, J. F. 1998; 25 (2): 334-341

    Abstract

    To determine the associations between running and radiographic hip osteoarthritis (OA), the progression of radiographic knee OA, and changes in bone mineral density (BMD) after 9 year followup in 28 members of a running club now aged 60-77 years and 27 nonrunner controls.Running subjects and nonrunning controls were matched for age (+/- 2 years), years of education, and occupation. All subjects underwent rheumatologic examination, completed annual questionnaires, and had radiographs taken of the knees in 1984, 1986, 1989, and 1993 and of the hips in 1993. BMD of the first lumbar spine vertebrae was obtained in 36 subjects by quantitative computed tomography (QCT) in 1984, 1986, 1989, and 1993. In 1993, knee radiographs were assessed in pairs (1984 and 1993), and hip radiographs were scored by 2 readers individually without knowledge of running status.Nine year radiographic results for both runners and nonrunners for the knees showed significant within-group progression of both osteophytes and total knee radiographic scores (p = 0.01 for runners and p = 0.05 for nonrunners) and joint space narrowing in nonrunners (p = 0.01). Runners tended to have higher radiographic scores, but no significant differences in between-group differences were seen in 1984 or 1993. Radiographic OA of the hip was not different between the groups. QCT of the first lumbar vertebrae for BMD in 1984, 1986, 1989, and 1993 was greater in runners than nonrunners (p = 0.01), but rates of change in QCT values were similar between the 2 groups (p < 0.001).The presence of radiographic hip OA and the progression of radiographic knee OA was similar for older runners and nonrunners. Lumbar spine BMD remained higher in runners, but changes in lumbar BMD were similar for runners and nonrunners over a 9 year period.

    View details for Web of Science ID 000071729900027

    View details for PubMedID 9489830

  • The clinical epidemiology of non-steroidal anti-inflammatory drug gastropathy CLINICAL SIGNIFICANCE AND POTENTIAL OF SELECTIVE COX-2 INHIBITORS Fries, J. F., Singh, G., Ramey, D. R. 1998: 57-65
  • Beyond health promotion: Reducing need and demand for medical care. Health Affairs Fries JF, Koop CE, Sokolov J, Beadle CE, Wright D. 1998: 70-84
  • Reducing the need and demand for medical care: implications for quality management and outcome improvement. Quality management in health care Fries, J. F. 1997; 6 (1): 34-44

    Abstract

    Reduction in medical need (illness burden) and demand (variability in resource use) can improve health, reduce medical care costs, and move us toward the goal of becoming a healthy society. Health promotion, redefined, works to enhance individual autonomy. The underlying conceptual bases and the abundant empiric documentation of the effectiveness of need and demand reduction are summarized here.

    View details for PubMedID 10176407

  • Can preventive gerontology be on the way? AMERICAN JOURNAL OF PUBLIC HEALTH Fries, J. F. 1997; 87 (10): 1591-1593

    View details for Web of Science ID A1997YD67100001

    View details for PubMedID 9357334

  • ''Arthritis specific'' global health analog scales assess ''generic'' health related quality-of-life in patients with rheumatoid arthritis JOURNAL OF RHEUMATOLOGY Fries, J. F., Ramey, D. R. 1997; 24 (9): 1697-1702

    Abstract

    Quality-of-life assessment is receiving increased attention as an outcome measure in rheumatoid arthritis (RA). The most widely used instruments use variations on a vertical visual analog scale (VAS). Since the Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scales (AIMS), and other instruments have long included a "global" arthritis horizontal VAS (GLOB), we studied whether these 2 approaches assess the same concept.We studied 663 patients with RA from 4 ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) centers and had them complete, in different parts of the same HAQ, the GLOB and the Torrance "feeling thermometer" (FT).The 2 scales were highly correlated (r = -0.676; p < 0.001). Reliability (estimated by 6 month test-retest) was 0.62 for the FT and 0.83 for the GLOB. The GLOB correlated more strongly than the FT with disability (r = 0.561 vs -0.507) and pain (0.630 vs -0.553). In stepwise regressions, pain and then disability were the dominant predictors of both GLOB and FT, followed weakly by joint count and then other variables. Patients with greater disability placed more emphasis on pain and patients with greater pain appeared to value more the contribution of disability. Change scores over 6 months between GLOB and FT correlated very well (-0.59)."Health" and "health related quality-of-life" are nearly equivalent terms. Since large longitudinal rheumatology databases contain thousands of global health VAS values, data for longitudinal quality-of-life studies in arthritis are already available, and this dimension may readily be added to longterm outcome assessment. In patients with RA, "generic" and "disease specific" assessments yield very similar results.

    View details for Web of Science ID A1997XU86700008

    View details for PubMedID 9292790

  • Patient education in arthritis: Randomized controlled trial of a mail-delivered program JOURNAL OF RHEUMATOLOGY Fries, J. F., Carey, C., MCSHANE, D. J. 1997; 24 (7): 1378-1383

    Abstract

    Self-management courses in arthritis have been shown to improve outcomes and to decrease medical resource utilization. We studied the effectiveness of a mail-delivered arthritis self-management program with the potential for extending these effects more broadly.Randomized controlled trial of 375 program participants and 434 controls over a 6 month period. Baseline and 6 month data were analyzed for each group and between groups by paired 2 sample t test. The intervention consists of health assessment questionnaires at 3 month intervals, with computer processed recommendation letters and reports individualized to age, diagnosis, education level, disability, pain, medication, and other patient-specific variables.At 6 months, outcomes of function (4.7%; 95% confidence limits 2.7, 6.7), decreased pain (9%; 2.8, 15.2), global vitality (7%; 2.8, 11.2), and joint count (28%; 20, 36) were improved in the program group compared with controls (p < 0.01). Exercise (35%; 26, 44) and self-efficacy (14.7%; 9, 20) were increased in the program group but not controls (p < 0.001). Doctor visits/year were decreased by 16% (3, 29) in the program group compared with controls (p < 0.05) and days missed work or confined to home decreased by 52% (-3, 107) in the program group compared with controls (p = 0.06). At one year, patients in the original program group continued to improve, and the control group, provided with the program in the second 6 months, showed improvement similar to the first 6 months of the original program group.A mail-delivered arthritis self-management program can positively affect patient outcomes and can decrease medical resource utilization.

    View details for Web of Science ID A1997XJ66600025

    View details for PubMedID 9228140

  • Response to therapy in rheumatoid arthritis is influenced by immediately prior therapy JOURNAL OF RHEUMATOLOGY Fries, J. F., WILLIAMS, C. A., Singh, G., Ramey, D. R. 1997; 24 (5): 838-844

    Abstract

    Clinicians do not often employ washout periods before prescribing a change in therapy for rheumatoid arthritis (RA). As a result, the observed effectiveness or lack of effectiveness of a new drug actually represents the effectiveness of that drug had the patient been taking placebo minus the residual effectiveness of the old drug.We studied new starts of selected disease modifying antirheumatic drugs (DMARD) and prednisone in 2,898 patients with RA from 8 ARAMIS data bank centers, broken into subgroups on the basis of immediately prior therapy. Therefore, we examined the hypothesis that the chances of a treatment being observed effective depend upon the immediately preceding treatment. Using intent-to-treat analysis, we analyzed the effects upon Health Assessment Questionnaire (HAQ) disability and pain scores an average of 9 months after the new drug start.Methotrexate reduced disability significantly except after intramuscular gold or hydroxychloroquine and it reduced pain significantly after all prior therapies. Hydroxychloroquine reduced disability significantly after nonsteroidal antiinflammatory drugs (NSAID) only, but disability increased after intramuscular gold; pain was decreased only after NSAID only. Prednisone had no consistent effect upon disability but was consistently associated with decreased pain. Greatest effectiveness was always seen with a new drug start after NSAID only treatment versus after DMARD treatment.The effectiveness of a newly started RA treatment after 9 months may be substantially influenced by immediately prior treatment. This finding provides an additional reason for concern about direct extrapolation of clinical trial data into clinical practice.

    View details for Web of Science ID A1997WY02100005

    View details for PubMedID 9150069

  • Exercise and the Health of the Elderly. The American journal of geriatric cardiology Fries, J. F. 1997; 6 (3): 24-32

    Abstract

    Most lifetime morbidity is concentrated in the later years as a consequence of increasing amounts of chronic illness and senescent changes. An ideal society would reduce this large illness burden by focusing upon increasing the incident age of first infirmity and compressing lifetime morbidity between that point and the average age at death; the "Compression of Morbidity." We compared progression of musculoskeletal disability, pain, and medical care costs by a longitudinal study of 537 members of a runners club and 423 community controls over a period of more than 8 years with an average initial age of 59 years, with extensive controls for selection bias. Exercising subjects developed disability at a rate only one-fourth that of the sedentary controls. Musculoskeletal pain was reduced by 20%. Medical care costs of exercisers were 25% less than controls. Mortality was significantly reduced in the exercising groups. These findings have substantial implications for health policies directed at increasing amounts of regular lifetime physical activity to improve the quality of life of our rapidly increasing senior population.

    View details for PubMedID 11416415

  • Risk factors for adult Still's disease JOURNAL OF RHEUMATOLOGY Sampalis, J. S., Medsger, T. A., Fries, J. F., Yeadon, C., Senecal, J. L., Myhal, D., Harth, M., GUTKOWSKI, A., Carette, S., Beaudet, F., Partridge, A. J., Esdaile, J. M. 1996; 23 (12): 2049-2054

    Abstract

    To assess risk factors for adult Still's disease (ASD).A matched case-control study of 60 patients with ASD and 60 same sex siblings closest in age was conducted. Subjects were recruited from cohorts in Eastern Canada, Pittsburgh, and the Arthritis, Rheumatism, and Aging, Medical Information Systems (ARAMIS). A questionnaire was used to obtain data on demographic characteristics, education, income, occupation, exposure to toxic substances, stress, and medical history.116 patients with ASD were identified, of which 104 participated. 86 identified same sex siblings, of which 60 replied. When compared to same sex siblings, ASD patients were similar with respect to education and occupation but had a trend to higher median income. There were no significant associations of ASD with smoking, alcohol consumption, individual toxic substances, vaccination, blood transfusion, minor or major surgery, pregnancy, or diet in the year preceding disease onset. There were no significant associations with tonsillectomy or adenoidectomy, appendectomy, asthma, hay fever, allergy shots, or pregnancy at any time preceding the onset of disease. There was a statistically nonsignificant increase in a history of exposure to coal dust [odds ratio (OR) 3.0; 95% confidence interval (CI) 0.30 to 28.84], in allergy preceding the onset of disease (OR 2.67; 95% CI 0.71 to 10.05), and in oral contraceptive use in the year preceding onset (OR 2.00; 95% CI 0.18 to 22.06). Stressful life events (OR 2.56; 95% CI 1.18 to 5.52) in the year preceding onset was significantly associated with increased risk for ASD. This positive association should be treated with caution unless confirmed by a separate study.This exploratory study of risk factors for ASD draws attention to stress as a potentially important risk factor, while likely excluding a considerable number of others.

    View details for Web of Science ID A1996VX84300010

    View details for PubMedID 8970040

  • Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis - A prospective observational cohort study ARCHIVES OF INTERNAL MEDICINE Singh, G., Ramey, D. R., MORFELD, D., Shi, H., Hatoum, H. T., Fries, J. F. 1996; 156 (14): 1530-1536

    Abstract

    Gastrointestinal tract (GI) complications associated with nonsteroidal anti-inflammatory drug (NSAID) use are the most common serious adverse drug reactions in the United States. Nonsteroidal anti-inflammatory drugs cause both minor GI side effects such as abdominal pain and vomiting and serious GI events such as ulcers and bleeding. This study evaluates the event rates for all NSAID-induced GI complications in patients with rheumatoid arthritis, describes the time course of these events, and evaluates the role of prophylactic therapy with antacids and H2 receptor antagonists.We studied 1921 patients with rheumatoid arthritis from 8 ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) centers. Patients were selected for the study if they were treated with NSAIDs and had at least 2.5 years of observation available. Information on GI complications attributed to NSAIDs was obtained from validated patient self-reports collected every 6 months and supplemented by review of hospital records for all hospitalizations.Approximately 15% of the 1921 patients reported an NSAID-induced GI side effect during the 2.5 year observation period. Forty-two patients had a serious GI complication requiring hospitalization; 34 of these 42 patients did not have a preceding GI side effect. Patients who were taking antacids and H2 receptor antagonists did not have a significantly lower risk for serious GI complications than did those not taking such medications. Asymptomatic patients taking these medications had a significantly higher risk for GI complications compared with those who did not take these medications (standardized odds ratio, 2.14;95% confidence interval, 1.06-4.32).A large majority of patients with serious GI complications do not have preceding mild side effects. Prophylactic treatment with antacids and H2 receptor antagonists is of questionable value and may increase the risk for subsequent serious GI complications.

    View details for Web of Science ID A1996UY33200006

    View details for PubMedID 8687261

  • Comparing health care expenditures between systemic lupus erythematosus patients in Stanford and Montreal ARTHRITIS AND RHEUMATISM Gironimi, G., Clarke, A. E., Hamilton, V. H., Danoff, D. S., Bloch, D. A., Fries, J. F., Esdaile, J. M. 1996; 39 (6): 979-987
  • Lymphoma and luekemia in rheumatoid arthritis: are they associated with azathioprine, cyclophosphamide, or methotrexate? Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases WILLIAMS, C. A., Bloch, D. A., Sibley, J., Haga, M., Wolfe, F., Raynauld, J. P., Singh, G., Hickey, A. R., Fries, J. F. 1996; 2 (2): 64-72

    Abstract

    Incident cases of lymphoma and leukemia in a cohort of 3824 rheumatoid arthritis (RA) patients from the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) database were identified, and the use of azathioprine, cyclophosphamide, and methotrexate was compared in a matched case-control study. Controls were matched on age, sex, year of study entry, disease duration, center, and years of follow-up. Twenty-four cases of lymphoma and 10 cases of leukemia were identified: 21% of patients with cancer versus 9% of controls had taken azathioprine [McNemar statistic 1.50 (p = 0.22), odds ratio 5.0 (95% confidence interval 0.6,236.5)]. Equal numbers of cases and controls (6% each) had taken cyclophosphamide and 18% of cases and 12% of controls had taken methotrexate [McNemar statistic 0.13 (p = 0.72), odds ratio 1.7 (0.3, 10.7)]. Results suggest but do not prove that RA patients taking azathioprine and methotrexate may have an increased risk of developing lymphoma. However, even if this increased risk can be confirmed, it accounts for only a small proportion of the greatly increased incidence of these malignancies in RA.

    View details for PubMedID 19078032

  • Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies ARTHRITIS AND RHEUMATISM Fries, J. F., WILLIAMS, C. A., MORFELD, D., Singh, G., Sibley, J. 1996; 39 (4): 616-622

    Abstract

    Therapeutic strategies for rheumatoid arthritis (RA) have been evolving from the traditional "pyramid" approach toward one based upon early and sustained use of disease-modifying antirheumatic drugs (DMARDs), in the hope of improving long-term health outcomes. However, few data to have been presented to document the effects of this approach. We sought to directly assess associations between consistent DMARD use and long-term functional outcomes.We studied 2,888 RA patients who were followed up prospectively for up to 20 years (average 9 years) at 8 databank centers. The independent variable was the proportion of patient encounters that resulted in treatment with > or = 1 DMARD (hydroxychloroquine, sulfasalazine, auranofin, intramuscular gold, D-penicillamine, methotrexate, and/or azathioprine). The dependent variable was each patient's last recorded Disability Index value from the Health Assessment Questionnaire (HAQ).Increased DMARD use was strongly associated with better long-term Disability Index values (P < 0.0001). The association was strengthened when restricted to more seriously affected (rheumatoid factor (RF)-positive) patients. The magnitude of the effect, unadjusted, was a difference of 0.53 HAQ Disability units (scale 0-3) between 100% DMARD use and 0%. Correlation coefficients ranged up to 0.26. Effects were similar for all disease duration periods (0-4, 5-9, 10-14, 15-19, and 20+ years). "Control" correlations, with variables computed to represent the proportion of time in which patients were taking either nonsteroidal anti-inflammatory drugs or prednisone, failed to show positive associations. A multiple linear regression model, which controlled for age, disease duration, sex, RF positivity, proportion of visits under a prednisone regimen, and initial disability level, included the proportion of time in which patients were taking DMARDs (P < 0.0001), with a model R2 of 0.54. These results were obtained despite an adverse selection bias in which more severely affected individuals were given DMARDS more frequently, and despite absence of data on drug use early in the disease course of many patients. Thus, these results, which suggest up to a 30 percent reduction in long term disability with consistent DMARD use, are most likely conservative.An association between consistent DMARD use and improvement in long-term functional outcomes in RA is supported by these data.

    View details for Web of Science ID A1996UD63800011

    View details for PubMedID 8630111

  • Safety of meloxicam: A global analysis of clinical trials BRITISH JOURNAL OF RHEUMATOLOGY Distel, M., Mueller, C., Bluhmki, E., Fries, J. 1996; 35: 68-77

    Abstract

    Meloxicam is a new preferential cyclooxygenase-2 (COX-2) inhibitor for the treatment of rheumatic disease. This paper presents a global safety analysis of data from meloxicam clinical studies, focusing on gastrointestinal (GI) adverse events. Meloxicam 7.5 and 15 mg (n = 893 and 3282) were compared with piroxicam 20 mg (n = 906), diclofenac 100 mg slow release (n = 324) and naproxen 750-1000 mg (n = 243). With respect to all GI adverse events, meloxicam 7.5 and 15 mg were significantly better than all comparators in a pooled analysis of double-blind studies in rheumatoid arthritis (RA) and osteoarthritis (OA). When examining non-serious GI events, severe GI events, discontinuous due to GI events, dyspepsia, abdominal pain and upper GI events, both meloxicam doses were significantly better than comparator non-steroidal anti-inflammatory drugs (NSAIDs) in most cases. Where statistical significance was not demonstrated, there was generally a trend in favour of meloxicam. With respect to upper GI perforations, ulcerations and bleedings, the most serious of NSAID-associated side-effects, meloxicam was better tolerated than the comparators, reaching statistical significance for piroxicam and naproxen. Meloxicam's improved GI safety profile is likely to be due to its preferential inhibition of inducible COX-2 relative to constitutive COX-1.

    View details for Web of Science ID A1996UJ92900013

    View details for PubMedID 8630641

  • Effectiveness and toxicity considerations in outcome directed therapy in rheumatoid arthritis JOURNAL OF RHEUMATOLOGY Fries, J. F. 1996; 23: 102-106
  • Effectiveness and toxicity considerations in outcome directed therapy in rheumatoid arthritis. journal of rheumatology. Supplement Fries, J. F. 1996; 44: 102-106

    Abstract

    New paradigms of disease modifying antirheumatic drug based treatment strategies for rheumatoid arthritis (RA) raise new questions of sequencing of medications and employment of combination therapy. A broader view of chronic illness indicates that nonbiologic and self-management factors influence disease course and necessitate inclusion of patient oriented outcome measures such as disability and pain. I discuss these and related issues, present a broad model of disease progression in RA, introduce the concept of the "therapeutic segment," describe the dependence of clinical results on immediately prior therapy, and suggest a new research approach into the merits of combination therapy. Effectiveness is not necessarily increased by addition of a 2nd drug, nor is toxicity necessarily increased by combination therapy.

    View details for PubMedID 8833065

  • Physical activity, the compression of morbidity, and the health of the elderly JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Fries, J. F. 1996; 89 (2): 64-68

    Abstract

    The Compression of Morbidity hypothesis envisions a potential reduction of overall morbidity, and of health care costs, now heavily concentrated in the senior years, by compression of morbidity between an increasing age of onset of disability and the age of death, increasing perhaps more slowly. For this scenario to be able to be widely achieved, largely through prevention of disease and disability, we need to identify variables which predict future ill health, modify these variables, and document the improvements in health that result. Physical activity is perhaps the most obvious of the variables which might reduce overall lifetime morbidity.

    View details for Web of Science ID A1996UC24300002

    View details for PubMedID 8683502

  • Prevention: Environmental factors and behavior SCANDINAVIAN JOURNAL OF RHEUMATOLOGY Fries, J. F. 1996: 111-111
  • Relationship of running to musculoskeletal pain with age - A six-year longitudinal study ARTHRITIS AND RHEUMATISM Fries, J. F., Singh, G., MORFELD, D., ODRISCOLL, P., Hubert, H. 1996; 39 (1): 64-72

    Abstract

    To determine, by longitudinal study, whether long-distance running, maintained for many years, is associated with increased musculoskeletal pain with age.A 6-year prospective longitudinal study of 410 runners' club members and 289 community controls, age 53-75 years at study initiation, was conducted. Subjects were also categorized as ever-runners (n = 488) and never-runners (n = 211). The primary dependent variable was pain score as indicated on a horizontal double-anchored analog scale; data for this variable were available beginning in 1987. Statistical adjustment for age, education level, smoking, alcohol consumption, history of arthritis, and presence of other major medical conditions was done by analysis of covariance. Further analyses of previously reported associations of regular vigorous physical activity with decreased disability and mortality after 9 years were performed.The degree of musculoskeletal pain was slightly lower in the exercise group compared with controls, and the difference was statistically significant for women but not for men. Average adjusted pain scores for men were 18.3 (SEM 0.8) in runners' club members, 20.2 (1.2) in controls, 18.6 (0.8) in ever-runners, and 20.3 (1.6) in never-runners. For women, these scores were 17.5 (1.8) in runners' club members versus 22.8 (1.4) in controls (P < 0.05), and 17.2 in ever runners versus 23.7 (1.5) in never-runners (P < 0.002). Disability had continued to develop in runners' club members at a rate only one-third that in the controls after 9 years of observation. Mortality over 9 years consisted of 51 deaths, of which 41 were in the control group and only 10 were among runners' club members.Vigorous running activity over many years is not associated with an increase in musculoskeletal pain with age, and there may be a moderate decrease in pain, particularly in women. Vigorous physical activity is associated with greatly decreased levels of disability and with decreased mortality rates.

    View details for Web of Science ID A1996TP96900008

    View details for PubMedID 8546740

  • Toward an understanding of NSAID-related adverse events: The contribution of longitudinal data SCANDINAVIAN JOURNAL OF RHEUMATOLOGY Fries, J. 1996: 3-8

    Abstract

    The ARAMIS (Arthritis, Rheumatism and Ageing Medical Information System) databanks have been used to objectify and quantify drug toxicity. The relative risk of a gastrointestinal (GI)-provoked hospitalization was more than five times greater in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) than in non-NSAID-treated patients, with an excess hospitalization rate of 1.3% per annum. Additionally, there was an excess GI-related death rate of around 3% in rheumatoid arthritis (RA) patients compared with the normal population. Age, previous NSAID-related GI events, prednisone use, higher doses and greater disability predicted high-risk patients. A toxicity index showed clear differences between NSAIDs, with aspirin, salsalate and ibuprofen emerging as the least toxic, and meclofenamate and indomethacin as the most toxic. Disease modifying anti-rheumatic drugs (DMARDs) were, surprisingly, found to have similar toxicity scores to the NSAIDs. This supports the contemporary practice of employing DMARDs earlier and more aggressively in the course of RA.

    View details for Web of Science ID A1996UH60200002

    View details for PubMedID 8628980

  • WORKSHOP REPORT - HEALTH-STATUS INSTRUMENTS UTILITIES JOURNAL OF RHEUMATOLOGY Bellamy, N., Boers, M., Felson, D., Fries, J., Furst, D., Henry, D., Liang, M., Lovell, D., March, L., Strand, V., Vanderlinden, S. 1995; 22 (6): 1203-1207
  • ARAMIS AND TOXICITY MEASUREMENT JOURNAL OF RHEUMATOLOGY Fries, J. F. 1995; 22 (5): 995-997

    Abstract

    Side effects of medications make up an important part of adverse outcomes experienced by patients with rheumatic diseases. Quantitative measures to assess toxicity, however, have not been available, and this lack has limited estimates of the magnitude of effects and of differences in side effects among different drugs. This paper describes the development of the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) Toxicity Index and the issues arising in construction of such an index, and reviews early results in comparing toxicities of antirheumatic drugs. Findings have had major value in revising therapeutic strategies for rheumatic diseases, particularly rheumatoid arthritis, and have set the stage for development of toxicity-therapeutic ratios for different drugs.

    View details for Web of Science ID A1995QY83600036

    View details for PubMedID 8587097

  • A CONTROLLED-STUDY OF THE LONG-TERM PROGNOSIS OF ADULT STILLS DISEASE AMERICAN JOURNAL OF MEDICINE Sampalis, J. S., Esdaile, J. M., Medsger, T. A., Partridge, A. J., Yeadon, C., Senecal, J. L., Myhal, D., Harth, M., GUTKOWSKI, A., Carette, S., Beaudet, F., Cush, J. J., Fries, J. F. 1995; 98 (4): 384-388

    Abstract

    To assess the long-term prognosis of patients with adult Still's disease for physical and psychological disability, pain, social functioning, social support, medication use, formal education, occupation, time lost from work, and family income, and to contrast these results with those of same-sex sibling controls.Patients were recruited from medical center-based cohorts in Pittsburgh and Eastern Canada and from a national survey of rheumatologists. Patients and same-sex sibling controls completed the Health Assessment Questionnaire for physical disability, the psychological and social function domains of the Arthritis Impact Measurement Scales, and the Interpersonal Skills Evaluation List questionnaire for social support, and replied to questions on medication use, formal education, occupation, time lost from work, and family income.One hundred four of 111 eligible adult Still's patients (94%) provided data. They identified 86 same-sex sibling controls, of whom 60 (70%) participated. The mean duration of adult Still's disease was 10 years. Approximately half of patients continued to require medication even 10 years after diagnosis. Patients had significantly higher levels of pain, physical disability, and psychological disability when compared with the controls. However, the levels of pain and physical disability were low compared to patients with other rheumatic diseases. Educational achievement, occupational prestige, social functioning and support, time lost from work, and family income were similar for both patients and controls.Despite causing disability, pain, and, in many, the need for long-term medication, patients with adult Still's disease are resilient. The disease did not interfere with educational attainment, occupational prestige, social functioning and support, time lost from work, or family income.

    View details for Web of Science ID A1995QQ86300011

    View details for PubMedID 7709952

  • POTENTIAL AND ACTUAL WORKDAYS LOST AMONG PATIENTS WITH HIV JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY Leigh, J. P., Lubeck, D. P., Farnham, P., Fries, J. F. 1995; 8 (4): 392-398

    Abstract

    How many more potential and actual workdays are lost by HIV patients than persons without HIV? To answer this question, we assessed differences in the number of workdays among a panel of AIDS patients, patients who were HIV positive but did not yet have AIDS, and comparison patients. The patients included persons who were employed and unemployed. Information on 1,346 patients was gathered from January 1, 1990, to December 31, 1992, as part of the ongoing ATHOS (AIDS Time-Oriented Health Outcome Study) study. Data were collected every 3 months on AIDS and HIV-positive patients and every 6-12 months on the comparison patients. At the end of the study (December 31, 1992), 856 people were still enrolled. A total of 5,507 panel data points covering 3 years were available. Data were analyzed with a linear regression model. We found that patients with AIDS reported 29-32 and HIV-positive patients reported 9-13 more potential and actual workdays lost out of the previous 90 than the comparison patients, other variables being equal. All p values were < 0.005, and most were < 0.0001. We conclude that (a) while the AIDS patients showed substantially more workdays lost than the comparison group, the HIV-positive group showed only a modest number of more days lost than the comparison group and (b) that previous estimates exaggerated indirect morbidity costs.

    View details for Web of Science ID A1995QL40600011

    View details for PubMedID 7882105

  • HOURS AT WORK AND EMPLOYMENT STATUS AMONG HIV-INFECTED PATIENTS AIDS Leigh, J. P., Lubeck, D. P., Farnham, P. G., Fries, J. F. 1995; 9 (1): 81-88

    Abstract

    To study differences in employment and work hours among three groups of HIV-infected and non-infected individuals.Data on 1263 patients seen in five different sites in California were drawn from the AIDS Time-Oriented Health Outcome Study. Three groups of patients were examined: AIDS patients, HIV-positives without diagnosed AIDS, and HIV-negatives. The HIV-negative patients were used as a comparison group in comparing hours worked by all patients, whether they worked or not; the probability of working, regardless of the number of hours; and work hours only for those patients who worked.Adjustment for covariates in a 2-equation econometric model reduced the difference in employment rates between the AIDS patients and the other two groups, suggesting that characteristics other than AIDS status account, in part, for their low employment rates. After adjustment, we did not find any statistically significant differences in employment probabilities or work hours between the HIV-positive patients without diagnosed AIDS and the comparison group. However, AIDS patients reported approximately 14 work hours fewer (P < 0.0001) and lower probabilities of employment (P < 0.0001) than the HIV-negative comparison group among all patients with and without jobs. Moreover, among those with jobs, patients with AIDS reported approximately 3 work hours fewer per week (P = 0.0385). No statistically significant differences in work hours were found between HIV-positives without diagnosed AIDS and comparison patients.AIDS patients were less likely to be employed than either of the other groups, but crude, unadjusted unemployment rates exaggerate the effect of AIDS. For those employed, AIDS patients work only 3 h less per week than either of the other groups.

    View details for Web of Science ID A1995QB05900011

    View details for PubMedID 7893445

  • MEASUREMENT OF HEALTH-STATUS IN CHILDREN WITH JUVENILE RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Singh, G., Athreya, B. H., Fries, J. F., Goldsmith, D. P. 1994; 37 (12): 1761-1769

    Abstract

    To develop and validate a self- or parent-administered instrument for measuring functional status in children with juvenile rheumatoid arthritis (JRA).We adapted the Stanford Health Assessment Questionnaire (HAQ) for use in children ages 1-19 years, by adding several new questions, such that for each functional area, there was at least 1 question relevant to children of all ages. The face validity of the instrument was evaluated by a group of 20 health professionals and parents of 22 healthy children. The questionnaire was then administered to parents of 72 JRA patients (mean age 9.1 years, onset type systemic in 16, polyarticular in 21, pauciarticular in 35).The instrument showed excellent internal reliability (Cronbach's alpha = 0.94), with a mean inter-item correlation of 0.6. The convergent validity was demonstrated by strong correlations of the Disability Index (average of scores on all functional areas) with Steinbrocker functional class (Kendall's tau b = 0.77, P < 0.0001), number of involved joints (Kendall's tau b = 0.67, P < 0.0001), and morning stiffness (Kendall's tau b = 0.54, P < 0.0001). Spearman's correlation coefficient between Disability Index scores from questionnaires administered to parents and those from questionnaires administered to older children (> 8 years) was 0.84 (n = 29; P < 0.001), showing that parents can accurately report for their children. The test-retest reliability, studied at a 2-week interval, revealed virtually identical Disability Index scores measured on the 2 occasions (0.96 versus 0.96; P > 0.9 by paired t-test; Spearman's correlation coefficient = 0.8, P < 0.002).The Childhood HAQ, which takes less than 10 minutes to complete, is a valid, reliable, and sensitive instrument for measuring functional status in children with JRA.

    View details for Web of Science ID A1994PW72800008

    View details for PubMedID 7986222

  • PATIENT EDUCATION AND HEALTH PROMOTION CAN BE EFFECTIVE IN PARKINSONS-DISEASE - A RANDOMIZED CONTROLLED TRIAL AMERICAN JOURNAL OF MEDICINE Montgomery, E. B., LIEBERMAN, A., Singh, G., Fries, J. F., Calne, D., Koller, W., Muenter, M., Olanow, C. W., Stern, M., Tanner, C., Tintner, R., Wasserstein, P., Watts, R. 1994; 97 (5): 429-435
  • RUNNING AND THE DEVELOPMENT OF DISABILITY WITH AGE ANNALS OF INTERNAL MEDICINE Fries, J. F., Singh, G., MORFELD, D., Hubert, H. B., Lane, N. E., Brown, B. W. 1994; 121 (7): 502-509

    Abstract

    To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age.8-year prospective, longitudinal study with yearly assessments.451 members of a runners' club and 330 community controls who were initially 50 to 72 years old (also characterized as "ever-runners" [n = 534] and "never-runners" [n = 247], respectively).The dependent variable was disability as assessed by the Health Assessment Questionnaire and separately validated in these participant cohorts. Covariates included age, sex, body mass index, comorbid conditions, education level, smoking history, alcohol intake, mean blood pressure, initial disability level, family history of arthritis, and radiologic evidence of osteoarthritis of the knee in a subsample.Initially, the runners were leaner, reported joint symptoms less frequently, took fewer medications, had fewer medical problems, and had fewer instances of and less severe disability, suggesting either that the average previous 12 years of running had improved health or that self-selection bias was present. After 8 years of longitudinal study, the differences in initial disability levels (0.026 compared with 0.079; P < 0.001) had steadily increased to 0.071 for runners compared with 0.242 for controls (P < 0.001). The difference was consistent for men and women. The rate of development of disability was several times lower in the runners' club members than in community controls; this difference persisted after adjusting for age, sex, body mass, baseline disability, smoking history, history of arthritis, or other comorbid conditions (slopes of progression of disability for the years 1984 to 1992, after adjusting for covariates: men in the runners' club, 0.004 [SE, 0.002]; community controls, 0.012 [SE, 0.002]; women in the runners' club, 0.009 [SE, 0.005]; community controls, 0.027 [SE, 0.004]; P < 0.002 for both sets of comparisons). In addition to differences in disability, there were significant differences in mortality between the runners' club members (1.49%) and community controls (7.09%) (P < 0.001). These differences remained significant after adjusting for age, sex, body mass, comorbid conditions, education level, smoking history, alcohol intake, and mean blood pressure (P < 0.002, conditional risk ratio for community controls compared with the runners, 4.27; 95% CI, 1.78 to 10.26).Older persons who engage in vigorous running and other aerobic activities have lower mortality and slower development of disability than do members of the general population. This association is probably related to increased aerobic activity, strength, fitness, and increased organ reserve rather than to an effect of postponed osteoarthritis development.

    View details for Web of Science ID A1994PJ10200005

    View details for PubMedID 8067647

  • Predictors of physical disability after age 50. Six-year longitudinal study in a runners club and a university population. Annals of epidemiology Hubert, H. B., Fries, J. F. 1994; 4 (4): 285-294

    Abstract

    Predictors of disability were studied over 6 years among 50- to 80-year-old members of a runners club (N = 407) and a university population (N = 299). Data have been collected annually since 1984 on sociodemographic characteristics, health habits, medical history, medication use, family history, psychological parameters, and physical disability as measured by the Health Assessment Questionnaire. Members of the runners club, compared to university participants, had better overall health and less disability at baseline (0.03 versus 0.08) and at 6-year follow-up (0.04 versus 0.24). Predictors of greater subsequent disability among university participants were greater baseline disability, greater medication use, greater number of pack-years of cigarette smoking, older age, being unmarried, higher blood pressure, history of arthritis, and less physical activity compared to one's peers. In addition, changes in characteristics during follow-up that were independently associated with greater disability were development of joint pain, arthritis, or bone fracture and increased body mass index. Predictors of greater disability in the runners group included greater baseline disability, being a nonrunner at baseline, greater dietary salt intake, more years of running at baseline, and greater frequency of physician visits for running injuries. Greater disability in this group also was associated with increases in medication use, declining alcohol consumption, and development of joint pain over 6 years. Results of this study suggest that physical disability is linked to a constellation of characteristics, health habits, medical history, comorbidities, and marital status. While self-selection bias cannot be ruled out entirely, these data are consistent with the hypothesis that those who engage in high levels of physical activity beyond middle age will continue to maintain better functional abilities.

    View details for PubMedID 7921318

  • ARTHRITIS AND MORTALITY IN THE EPIDEMIOLOGIC FOLLOW-UP TO THE NATIONAL-HEALTH AND NUTRITION EXAMINATION SURVEY-I BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Leigh, J. P., Fries, J. F. 1994; 71 (1): 69-86

    Abstract

    Subsets were analyzed of respondents from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey I (NHANES I) who (1) answered a general arthritis question reflecting whether a doctor told the respondent that she or he had arthritis, (2) answered seven pain, swelling, and stiffness questions, and (3) had radiographs of knees and hips assessed for osteoarthritis at the time of the initial survey during the early 1970s. Data for the follow-up were collected between 1982 and 1984 and included 1,491 fatalities in the largest subsample analyzed here. The dependent variable was months of survival after the initial interview. No distinction was drawn between rheumatoid arthritis versus osteoarthritis. The NHANES I contained only limited information on rheumatoid arthritis versus osteoarthritis. Additional covariates included age, age squared, education, race, marital status, diastolic blood pressure, and body mass. After adjusting for age, no statistically significant associations emerged between answers to the general arthritis questions or any of the seven pain questions on the one hand, and mortality on the other. Similar statistically insignificant results were found when the association between radiographic diagnoses of osteoarthritis in the hips and months of survival was considered after adjusting for age. These statistically insignificant results persisted in repeated testing, which alternately included and excluded a number of covariates, and in separate subsamples of women, men, and persons older and younger than age 50. Some evidence was found, however, for a negative, statistically significant association between radiographic knee diagnoses of osteoarthritis and survival, especially among women, even after adjusting for covariates. These mixed results (1) do not discredit findings elsewhere suggesting that rheumatoid arthritis is associated with early death, since it is likely that the great majority of respondents answering in the affirmative to the general arthritis or seven pain questions in the NHANES I had osteoarthritis, and (2) suggest that future surveys should make greater attempts to distinguish between rheumatoid arthritis and osteoarthritis.

    View details for Web of Science ID A1994NT99600007

    View details for PubMedID 8069278

  • Criteria for rheumatic disease. Different types and different functions. The American College of Rheumatology Diagnostic and Therapeutic Criteria Committee. Arthritis and rheumatism Fries, J. F., Hochberg, M. C., Medsger, T. A., Hunder, G. G., Bombardier, C. 1994; 37 (4): 454-462

    Abstract

    Criteria sets formalize our approach to studying the etiology, course, and management of rheumatic diseases, and provide a conceptual base for measuring future improvements in clinical care. They focus our clinical objectives and improve our clinical research activities. They are dynamic, evolving, and will certainly undergo major changes. Understanding the purposes of specific criteria sets and the differences between different criteria categories is crucial for understanding the rheumatic disease literature and for the design and conduct of clinical and epidemiologic investigations.

    View details for PubMedID 7605403

  • THE MORTALITY OF RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Wolfe, F., MITCHELL, D. M., Sibley, J. T., Fries, J. F., Bloch, D. A., WILLIAMS, C. A., SPITZ, P. W., Haga, M., KLEINHEKSEL, S. M., CATHEY, M. A. 1994; 37 (4): 481-494

    Abstract

    To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA).RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died.The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.

    View details for Web of Science ID A1994NF04400007

    View details for PubMedID 8147925

  • Health care demand management. Medical interface Fries, J. F. 1994; 7 (3): 55-58

    Abstract

    Health care costs, rising prohibitively, are related in part to the magnitude of the illness burden (need) and to the services requested (demand), which in turn are related in part to preventable illness and to inconsistent and unproductive requests for utilization. A broadened model of health promotion is suggested by the author, with the twin goals of health improvement and of cost reduction. The model includes health risk reduction goals and selected screening tests, but also includes cost-focused features. Eight such programs have recently been proven to reduce medical costs by 20%, potentially representing savings of $200 billion annually, but such programs are not yet widely disseminated.

    View details for PubMedID 10133059

  • CAN PREVENTION LOWER HEALTH COSTS BY REDUCING DEMAND HOSPITALS & HEALTH NETWORKS Fries, J. F. 1994; 68 (3): 10-10

    View details for Web of Science ID A1994MV96400006

    View details for PubMedID 8293045

  • CORRELATIONS BETWEEN EDUCATION AND ARTHRITIS IN THE 1971-1975 NHANES-I SOCIAL SCIENCE & MEDICINE Leigh, J. P., Fries, J. F. 1994; 38 (4): 575-583

    Abstract

    Data from the National Health and Nutrition Examination Survey I, 1971-1975 (NHANES I) were used to analyze associations among highest education level and arthritis. The dependent variables indicated whether the respondent had ever been diagnosed with any form of arthritis by a physician (10,678 women and 7243 men) or whether physician X-ray readings suggested arthritis of the knee (3491 women and 3119 men). These variables did not distinguish between osteo- and rheumatoid arthritis. It is likely that the great majority of the sample reporting or diagnosed with arthritis had osteoarthritis. There were strong univariate correlations between answers to the general arthritis question and the knee question on the one hand and gender, age, body mass, schooling, income and employment on the other. Respondents' education level was found to be strongly and negatively associated with self-reported arthritis in the larger samples both before and after controls were entered for employment, income and potential biological risk factors. The association between self-reported arthritis or arthritis of the knees and education was weaker for men, but not for women after employment and income were accounted for. When body mass was accounted for, the association between self-reported arthritis or arthritis of the knees and education was weaker among women but not men. Long-run preventive strategies to combat osteoarthritis ought to consider investments in education.

    View details for Web of Science ID A1994MT98500011

    View details for PubMedID 8184320

  • CHANGES IN HEALTH-STATUS AFTER 1 YEAR FOR PERSONS AT-RISK FOR AND WITH HIV-INFECTION PSYCHOLOGY & HEALTH Lubeck, D. P., Fries, J. F. 1994; 9 (1-2): 79-92
  • Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study. American journal of health promotion Fries, J. F., Harrington, H., Edwards, R., KENT, L. A., Richardson, N. 1994; 8 (3): 216-223

    Abstract

    Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

    View details for PubMedID 10146667

  • COMPARATIVE TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY AGENTS PHARMACOLOGY & THERAPEUTICS Singh, G., Ramey, D. R., MORFELD, D., Fries, J. F. 1994; 62 (1-2): 175-191

    Abstract

    Comparative toxicity of non-steroidal anti-inflammatory drugs was assessed using the Stanford Toxicity Index consisting of weighted symptoms, laboratory abnormalities and hospitalizations in 2976 consecutively enrolled rheumatoid arthritis patients from eight data bank centers with 27,936 patient-years of observation. Scores ranged from 1.77 (SE 0.20) for aspirin to 5.94 (SE 0.92) for meclofenamate, with many differences between drugs being 2- to 3-fold and highly statistically significant. Results are consistent with our prior data, persist when assessed by several different scoring algorithms, are consistent across data bank centers and are consistent with data of others. There are major and reproducible differences in the overall toxicity of different non-steroidal anti-inflammatory drugs.

    View details for Web of Science ID A1994NX95600009

    View details for PubMedID 7991642

  • EDUCATION, GENDER, AND THE COMPRESSION OF MORBIDITY INTERNATIONAL JOURNAL OF AGING & HUMAN DEVELOPMENT Leigh, J. P., Fries, J. F. 1994; 39 (3): 233-246

    Abstract

    According to the Compression of Morbidity (CM) hypothesis, people who exercise, eat nutritiously, do not smoke, and maintain good weight, i.e., people who practice healthy habits, will be more likely to live free of disabling diseases and injuries up until the last few months or years of life. The Increasing Misery (IM) hypothesis, on the other hand, holds that preventive health measures will extend life expectancy but will also increase the number of infirm years. The CM theory implies that curves of morbidity or disability with age should become increasingly "rectangular" for groups who practice healthy habits in the broadest sense. The IM theory does not. This Rectangularization hypothesis is examined with cross-sectional data measuring disability from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey, I (NHEFS), using years of schooling as the independent variable proxy representing favored health status, and examining interactions with age. A modified version of the Disability Index (DI) from the Stanford Health Assessment Questionnaire (HAQ) is used to measure disability. In some analyses, deceased subjects were assigned the worst disability score. Four subsamples of women and men, fifty years old and over, alive and deceased in 1982-84, were analyzed. Female, and especially male, subsamples which included the deceased provided evidence for the CM hypothesis. Results for the subsamples of those remaining alive in 1982-84 were ambiguous. However, lifetime (over age 50) cumulative disability was 21 to 60 percent less for the more educated than the less educated, depending upon whether deceased were included or excluded. If higher education level is an appropriate surrogate for the effect of good health practices, then extending such practices will result in less, rather than more, lifetime disability.

    View details for Web of Science ID A1994PW25600003

    View details for PubMedID 7875915

  • A REEVALUATION OF ASPIRIN THERAPY IN RHEUMATOID-ARTHRITIS ARCHIVES OF INTERNAL MEDICINE Fries, J. F., Ramey, D. R., Singh, G., MORFELD, D., Bloch, D. A., Raynauld, J. P. 1993; 153 (21): 2465-2471

    Abstract

    Aspirin therapy has been largely superseded by prescription nonsteroidal anti-inflammatory drug (NSAID) therapy in rheumatoid arthritis, in part because of premarketing studies suggesting lesser toxic effects for NSAIDs than for aspirin. This study evaluates these toxic effects in a postmarketing population of patients with rheumatoid arthritis.We studied 1521 consecutive courses of aspirin and 4860 courses of NSAIDs in patients with rheumatoid arthritis from eight Arthritis, Rheumatism, and Aging Medical Information System Post-marketing Surveillance Centers. Toxicity index scores were generated from symptoms, laboratory abnormalities, and hospitalizations, weighted for variable severity and severity of side effect.The toxicity index was only 1.37 (SE = 0.10) for aspirin and 1.87 to 2.90 for selected nonsalicylate NSAIDs. These differences were consistent across centers and remained after statistical adjustment for differing patient characteristics. There was a different toxicity with different aspirin preparations, with a score for plain aspirin of 1.36 (SE = 0.23), for buffered aspirin of 1.10 (0.20), and for enteric-coated aspirin preparations of 0.92 (0.14). Most important, there were strong dose effects, with a score of 0.73 (0.09) for 651 to 2600 mg daily, 1.08 (0.17) for 2601 to 3900 mg, and 1.91 (0.38) for more than 3900 mg. The average aspirin dose taken was only 2665 mg/d, approximately eight "tablets," compared with 3600 to 4800 mg/d used in the 16 pivotal premarketing studies reviewed. Average NSAID doses were, on the other hand, lower in premarketing trials (eg, naproxen 500 mg/d vs 773 mg/d in the Arthritis, Rheumatism, and Aging Medical System clinical practices).Aspirin therapy, in doses commonly employed in practice, has an excellent safety profile in rheumatoid arthritis, and it is the least costly NSAID. The safety advantage is explained primarily by a dose effect and secondarily by possible differences between formulations. Newer management strategies for rheumatoid arthritis emphasize NSAID use as symptomatic therapy and use of disease-modifying anti-rheumatic drug therapy for anti-inflammatory objectives. Thus, the original recommendation for "anti-inflammatory" doses of aspirin now is less easily justified. Aspirin therapy merits reconsideration as adjunctive therapy for the management of rheumatoid arthritis.

    View details for Web of Science ID A1993ME65900008

    View details for PubMedID 8215751

  • A CANADIAN STUDY OF THE TOTAL MEDICAL COSTS FOR PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS AND THE PREDICTORS OF COSTS ARTHRITIS AND RHEUMATISM Clarke, A. E., Esdaile, J. M., Bloch, D. A., Lacaille, D., Danoff, D. S., Fries, J. F. 1993; 36 (11): 1548-1559

    Abstract

    We conducted a cost identification analysis on 164 consecutive patients with systemic lupus erythematosus (SLE) who entered the Montreal General Hospital Lupus Registry between January 1977 and January 1990, compared their costs to the population of Quebec, and determined the predictors of cost.In January 1990 and 1991, participants completed questionnaires on health services utilization and on employment history over the preceding 6 months, as well as on functional, psychological, and social well-being. The societal burden of SLE was determined in terms of direct costs (all resources consumed in patient care) and indirect costs (wages lost due to lack of work force participation because of morbidity).The mean total annual cost for 1989, as assessed in January 1990 and expressed in 1990 Canadian dollars, was $13,094. Although only 44% of the patients were fully employed, indirect costs were responsible for 54% of this total ($7,071). Ambulatory costs, primarily diagnostic procedures, medications, and visits to health care professionals, comprised 55% of direct costs ($3,331). The results of the 1990 cost determination were similar. On average, hospitalizations among SLE patients were 4 times more frequent than among the general population of Quebec (matched for age and sex), and the number of ambulatory visits to physicians was double that for the average resident of Quebec. Higher 1989 values of creatinine and a poorer level of physical functioning were the best predictors of higher 1990 direct costs (R2 = 0.29). A poorer SLE well-being score, a combination of education and employment status, and a weaker level of social support were the best predictors of higher indirect costs (R2 = 0.29).The direct and indirect costs for patients with SLE are substantial, and their respective predictors are distinct. Direct costs arise from organic complications which induce functional disability. Predictors of indirect costs are potentially amenable to psychological or social interventions and may be more easily modified than the determinants of direct costs, thereby improving patient outcome while simultaneously reducing disease costs.

    View details for Web of Science ID A1993MF62700008

    View details for PubMedID 8240431

  • Reducing need and demand. The Healthcare Forum journal Fries, J. F. 1993; 36 (6): 18-23

    View details for PubMedID 10129746

  • PROGRESSION OF FUNCTIONAL DISABILITY IN PATIENTS WITH RHEUMATOID-ARTHRITIS - ASSOCIATIONS WITH RHEUMATOLOGY SUBSPECIALTY CARE ARCHIVES OF INTERNAL MEDICINE Ward, M. M., Leigh, J. P., Fries, J. F. 1993; 153 (19): 2229-2237

    Abstract

    To determine whether patients with rheumatoid arthritis and their physicians make appropriate decisions regarding referral to rheumatologists and the need for continuing rheumatology care, we examined the relationship between the progression of functional disability in these patients and their use of rheumatology subspecialty care over time.A cohort of 282 patients with rheumatoid arthritis was followed prospectively for up to 10 years. Participants were categorized into three subgroups based on the pattern of care received from rheumatologists over the study period: patients who were never treated by a rheumatologist; patients treated by a rheumatologist only intermittently; and patients treated by a rheumatologist at least once during each 6-month study period. The outcome was the rate of progression of functional disability, measured using the Health Assessment Questionnaire Disability Index.Among the 52 patients who had not been referred to a rheumatologist, 30 (58%) had rates of progression of functional disability that were stable or improving over time (rate < 0.01 Disability Index units per year), while 22 (42%) had rates that were worsening (rate > or = 0.01 Disability Index units per year). Among patients treated by rheumatologists, the average rate of progression was substantially lower among the 69 patients who were treated regularly by a rheumatologist than among 161 patients treated by rheumatologists intermittently (0.008 Disability Index units per year vs 0.020 Disability Index units per year). This difference was associated with more intensive use of second-line antirheumatic medications, and more frequent joint surgeries, among patients treated by rheumatologists on a regular basis.Most patients with rheumatoid arthritis in this community cohort were treated by a rheumatologist, but 42% of those not referred had progressively increasing functional disability. Among patients treated by rheumatologists, those who had continuing care from rheumatologists experienced lower rates of progression of functional disability than those who had only intermittent care. These results suggest that use of rheumatology subspecialty care is associated with better health outcomes in rheumatoid arthritis.

    View details for Web of Science ID A1993MA52700007

    View details for PubMedID 8215726

  • FRACTURES IN RHEUMATOID-ARTHRITIS - AN EVALUATION OF ASSOCIATED RISK-FACTORS JOURNAL OF RHEUMATOLOGY Michel, B. A., Bloch, D. A., Wolfe, F., Fries, J. F. 1993; 20 (10): 1666-1669

    Abstract

    Our purpose was to identify factors indicative of a high fracture risk during the disease course of rheumatoid arthritis (RA).In 1110 patients (879 women and 231 men) with RA from five Arthritis, Rheumatism and Aging Medical Information System centers, information from history, clinical and laboratory examination, outcome assessment, and therapy was evaluated for association with the 226 first fractures having occurred during the years from 1975 to 1988.The mean age of the patients was 54 years, the mean time of observation was 8 years. Multivariate analyses identified the following factors to be associated with fracturing: years taking prednisone, previous diagnosis of osteoporosis, disability, age, lack of physical activity, female sex, disease duration, impaired grip strength, and low body mass.We conclude that patients with RA at greatest risk for fracturing are easily identified by using a few clinical variables. These findings support encouragement of active lifestyle habits and avoidance of longterm administration of corticosteroids in patients with RA.

    View details for Web of Science ID A1993MG97800007

    View details for PubMedID 8295176

  • THE RELATIVE TOXICITY OF ALTERNATIVE THERAPIES FOR RHEUMATOID-ARTHRITIS - IMPLICATIONS FOR THE THERAPEUTIC PROGRESSION SEMINARS IN ARTHRITIS AND RHEUMATISM Fries, J. F., WILLIAMS, C. A., Ramey, D. R., Bloch, D. A. 1993; 23 (2): 68-73

    Abstract

    The traditional pyramid for the therapeutic progression in rheumatoid arthritis (RA) is based on assumptions that RA is a mild disease, that nonsteroidal antiinflammatory drugs (NSAIDs) have low toxicity, and that disease-modifying antirheumatic drugs (DMARDs) are extremely toxic. This article reviews data from ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System), casting strong doubt on these assumptions. NSAIDs result in 1.3% excess gastrointestinal hospitalizations per year. Mortality rates in RA are far above those expected from age- and sex-matched populations. Individual NSAIDs show widely different overall quantitative toxicity indices, as do individual DMARDs. However, the ranges of toxicity of the two classes of drugs show nearly complete overlap. It is suggested that the new therapeutic progression in RA should emphasize initial use of DMARDs, beginning with the least toxic.

    View details for Web of Science ID A1993MF17600010

    View details for PubMedID 8278821

  • SEASONAL-VARIATION IN THE ONSET OF WEGENERS GRANULOMATOSIS, POLYARTERITIS-NODOSA AND GIANT-CELL ARTERITIS JOURNAL OF RHEUMATOLOGY Raynauld, J. P., Bloch, D. A., Fries, J. F. 1993; 20 (9): 1524-1526

    Abstract

    The hypothesis of a seasonal pattern in the onset of symptoms for some vasculitides has been raised in previous small studies.Using the data collected by the American College of Rheumatology (ACR) Subcommittee on Classification of Vasculitis, we specifically tested for a higher proportion of onset of symptoms in winter, lower in summer, and intermediate for the other seasons for polyarteritis nodosa (PAN) and Wegener's granulomatosis. We also tested for a higher proportion of onset of symptoms in the spring-summer months for giant cell arteritis (GCA).The results of our study support the hypothesis of a seasonal trend for the onset of symptoms of Wegener's granulomatosis (p = 0.04) as described previously. No seasonal pattern was found for the other vasculitides studied (PAN and GCA).

    View details for Web of Science ID A1993MJ67800013

    View details for PubMedID 7909333

  • UNILATERAL PTOSIS AS AN INITIAL MANIFESTATION OF D-PENICILLAMINE INDUCED MYASTHENIA-GRAVIS JOURNAL OF RHEUMATOLOGY Raynauld, J. P., Lee, Y. S., KORNFELD, P., Fries, J. F. 1993; 20 (9): 1592-1593

    Abstract

    We describe 2 patients presenting with isolated unilateral ptosis without other signs of cranial or peripheral nerve involvement or sympathetic denervation. Both patients (one case of progressive systemic sclerosis and one of rheumatoid arthritis) were currently taking D-penicillamine. In these cases, the ptosis was reversed a few minutes after a Tensilon test, hallmark of myasthenia gravis. Antibodies to acetylcholine receptors were present. Myasthenia gravis should be suspected with ptosis without other cranial nerve involvement or miosis, even if the ptosis is unilateral. Thus, unilateral ptosis can be the first manifestation of a toxic side reaction to D-penicillamine.

    View details for Web of Science ID A1993MJ67800027

    View details for PubMedID 8164222

  • REDUCING HEALTH-CARE COSTS BY REDUCING THE NEED AND DEMAND FOR MEDICAL-SERVICES NEW ENGLAND JOURNAL OF MEDICINE Fries, J. F., Koop, C. E., Beadle, C. E., COOPER, P. P., England, M. J., Greaves, R. F., SOKOLOV, J. J., Wright, D. 1993; 329 (5): 321-325

    View details for Web of Science ID A1993LN62100006

    View details for PubMedID 8321260

  • REDUCING ATTRITION BIAS WITH AN INSTRUMENTAL VARIABLE IN A REGRESSION-MODEL - RESULTS FROM A PANEL OF RHEUMATOID-ARTHRITIS PATIENTS STATISTICS IN MEDICINE Leigh, J. P., Ward, M. M., Fries, J. F. 1993; 12 (11): 1005-1018

    Abstract

    This study proposes an econometric technique to reduce attrition bias in panel data. In the simplest case, one estimates two regressions. The first is a probit regression based on sociodemographic and clinical characteristics measured at baseline. The probit regression estimates the probability that subjects stay or leave over the duration of the study. We insert the predicted probabilities from the probit regression into an inverse Mills ratio (IMR) or hazard rate to form an instrumental variable. We use this instrumental variable subsequently as an additional covariate in a second regression model that attempts to explain fluctuations in the dependent variable. The second regression, which is linear, includes only subjects who remained in the study. In alternative models, instrumental variables are created using predicted values from least squares and logit regressions estimating the probability that subjects stay or leave. The use of the instrumental variables reduces the effects of attrition bias in the linear regression model. We applied the technique to a panel of patients with rheumatoid arthritis (RA) enrolled in 1981 and followed through 1990. We attempted to predict values for a measure of functional disability recorded in 1990 with use of covariates measured in 1981. The dependent variable was an index of disability in 1990 and the independent variables (covariates) included the disability index from 1981, the years of duration of RA, gender, marital status, education, and age in 1981. The correction technique suggested that ignoring attrition bias would underestimate the strength of associations between being female and the subsequent disability index, and overestimate the strength of associations between being married spouse present, age, and the initial disability index on the one hand and the subsequent disability index on the other.

    View details for Web of Science ID A1993LJ06700002

    View details for PubMedID 8341862

  • THE RELATIONSHIP BETWEEN SPINAL AND PERIPHERAL OSTEOARTHRITIS AND BONE-DENSITY MEASUREMENTS JOURNAL OF RHEUMATOLOGY BELMONTESERRANO, M. A., Bloch, D. A., Lane, N. E., Michel, B. E., Fries, J. F. 1993; 20 (6): 1005-1013

    Abstract

    To determine the influence of osteoarthritis (OA) on bone density measurements and whether OA at one site is associated with OA at other sites.Nonrandomized, cross sectional observational study; secondary analysis of a general population database. Sixty-four subjects derived from a longitudinal study of long distance runners and community controls had a complete peripheral radiographic evaluation for osteoarthritic changes in hands, knees, and lumbar spine. Forty-four of these were studied in 1984 with quantitative computed tomography (QCT) of L1, and 54 were studied in 1988 with 153-Gd dual photon absorptiometry (DPA) in the spine and total body. Thirty-four subjects had all measurements done.Total body and lumbar spine DPA were positively correlated with radiological scores of OA in the spine and knees, with coefficients ranging between 0.467 to 0.530 (p < 0.001 in all cases). This correlation was principally associated with spinal spurs and knee sclerosis. Results of stepwise multiple linear regression modeling for QCT included age, spine sclerosis, knee sclerosis and knee spurs as the main predictors of bone mineral density (BMD). For DPA measurements, spine spur score was a useful regressor for all the models. Altogether, the percentage of variance accounted for by individual radiological OA variables was 27.4% for lumbar QCT, 27.3% for lumbar BMD, 7.3% for total spine BMD, and 45.2% for total body BMD. OA scores at different sites were not correlated, although repeated assessment at the same site showed very close correlation.All methods used to determine BMD showed a highly significant positive correlation between lumbar and knee radiological OA and bone mineral content both in the spine and the total body. Thus, our results support the hypothesis that OA is negatively correlated with osteopenia. OA, as seen in this population, was not a generalized condition, but rather, was site specific.

    View details for Web of Science ID A1993LH11200019

    View details for PubMedID 8350306

  • TOBIT, FIXED EFFECTS, AND COHORT ANALYSES OF THE RELATIONSHIP BETWEEN SEVERITY AND DURATION OF RHEUMATOID-ARTHRITIS SOCIAL SCIENCE & MEDICINE Leigh, J. P., Fries, J. F. 1993; 36 (11): 1495-1502

    Abstract

    Three methodological problems are commonly faced by researchers investigating relationships between severity and duration of illness among patients with rheumatoid arthritis (RA). (1) Linear regression techniques yield biased estimates when measures of severity are continuous but range between and include limiting values such as 0 and 3. (2) Data from the same patient over time are typically pooled together with data from different patients at the same time and over time. Models are then used that do not account for the statistical problems that can result from pooling. (3) Persons with varying years of duration of disease are typically combined and analyzed without any special attention to cohort effects. Changes in severity over time for cohorts of patients with fewer than 10 years of duration may be different from changes in severity of patients with more than 20 years of duration from the onset of the disease. In this study, severity is measured by the 0-3 disability scale in the Stanford Health Assessment Questionnaire (HAQ). Duration is measured by self-report of the onset of symptoms by subjects. Popular techniques are borrowed from econometrics--Tobit, Fixed Effects, and dummy variables for Cohort Models--that were developed to address three analogous problems in economic data. The three economic techniques are applied separately and together using data collected by Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) on 330 RA patients in 1981 who were followed until 1989. Although the Tobit technique does not appear to be especially useful with these data, Fixed Effects and Cohort Models do appear to be useful.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1993LD20400012

    View details for PubMedID 8511637

  • QUALITY-OF-LIFE AND HEALTH-SERVICE USE AMONG HIV-INFECTED PATIENTS WITH CHRONIC DIARRHEA JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Lubeck, D. P., Bennett, C. L., Mazonson, P. D., Fifer, S. K., Fries, J. F. 1993; 6 (5): 478-484

    Abstract

    Health-related quality of life and the utilization of health resources are important components of the evaluation of patient outcome in HIV infection because medical problems are often progressive and debilitating, and treatment is palliative. We evaluated quality-of-life measures and resource utilization of patients with AIDS and/or CD4 lymphocytes < 200 who had symptoms of chronic diarrhea and compared them with similar patients with AIDS and/or CD4 lymphocytes < 200 without diarrheal symptoms. Annual charges were 50% higher for patients with chronic diarrhea ($24,567 versus $14,471 for the comparison group, p < 0.01). Higher charges for the patients with diarrhea were a result of more physician visits and diagnostic testing. Quality-of-life scores were poor for all patients, but deterioration over the year in role functioning (social activity, daily living, energy, cognition) and general health was clearly evident (p < 0.01) for the patients with chronic diarrhea. These patients also suffered significant work loss and reported greater need for assistance in the home. These data suggest that HIV-infected patients with diarrhea experience marked decreases in quality of life and that care for patients with chronic diarrhea is costly. Relatively little attention has been paid to this debilitating syndrome, and current treatment options rarely provide permanent relief. Research and innovation in this area are needed; an estimated 25-50% of HIV-positive individuals suffer from this symptom complex.

    View details for Web of Science ID A1993KY56500008

    View details for PubMedID 8483111

  • 2-YEAR RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF A HEALTH PROMOTION PROGRAM IN A RETIREE POPULATION - THE BANK-OF-AMERICA STUDY AMERICAN JOURNAL OF MEDICINE Fries, J. F., Bloch, D. A., Harrington, H., Richardson, N., Beck, R. 1993; 94 (5): 455-462

    Abstract

    To evaluate the effectiveness of a health promotion program in a retiree population in terms of health risk reduction and reduction in medical costs.Randomized controlled trial.Bank of America retirees (n = 4,712), divided into 33 retiree club regions, were randomized into 3 groups and followed for 24 months by patient report and claims experience. Group 1, the intervention group, received a low-cost ($30/year), individualized, serially reinforcing health promotion program including risk appraisal, recommendation letters, and self-management materials, delivered entirely through the mail. Group 2 received risk appraisals only, without feedback, for the first 12 months and subsequently the full intervention for the second 12 months. Group 3 was followed with claims data only. Participation rates of 57% at 1 year and 47% at 2 years were achieved.Overall health risk scores improved by 12% at 12 months compared with control (p < 0.001) and by 23% (from baseline) at 24 months (p < 0.001). Individual health habit changes were favorable for all parameters studied, and were highly statistically significant for most variables. Similar health risk reductions were seen in age groups of 55 to 65 years, 65 to 75 years, and over 75. Cost reduction differences were more than 20% by self-report (p < 0.01) and 10% by claims experience (p = 0.02) at 12 months. For the randomized controlled period of the first 12 months, reductions averaged $164 in the intervention group contrasted with an average increase of $15 in the combined control groups.Risk reduction programs directed at retiree populations can improve health risk status and can reduce costs.

    View details for Web of Science ID A1993LC87400002

    View details for PubMedID 8498389

  • PLATONIC OUTCOMES JOURNAL OF RHEUMATOLOGY Fries, J. F., Ramey, D. R. 1993; 20 (3): 415-417

    View details for Web of Science ID A1993KU05800001

    View details for PubMedID 8478844

  • RISK-FACTORS FOR PHYSICAL-DISABILITY IN AN AGING COHORT - THE NHANES-I EPIDEMIOLOGIC FOLLOW-UP-STUDY JOURNAL OF RHEUMATOLOGY Hubert, H. B., Bloch, D. A., Fries, J. F. 1993; 20 (3): 480-488

    Abstract

    Successful improvement in health in our increasingly aged population will depend in substantial part on reduction of age specific disability levels. In turn, the epidemiologic model suggests that this requires identification of risk factors, development of intervention models, and testing of these models. We attempted to identify risk factors for physical disability among 4,428 50-77-year-olds using baseline data collected in the first National Health and Nutrition Examination Survey (NHANES I) (1971-1975) linked to disability data collected 10 years later in the NHANES I Epidemiologic Followup Study. Results of forward stepwise linear regression analysis showed that the major characteristics contributing to greater disability (explaining at least 1% of the variability in scores) were older age at baseline, less nonrecreational activity, arthritis history, less education, female sex, and greater body mass index at age 40. Other factors associated with greater disability included a history of asthma, cardiovascular disease, abnormal urine test, less recreational activity, higher sedimentation rate, rheumatic fever history, lower caloric intake, positive musculoskeletal findings, histories of polio and allergies, lower family income, elevated blood pressure, lower serum albumin, history of tuberculosis, glucose in the urine, and histories of hip or spine fracture, chronic pulmonary disease, and kidney disease.

    View details for Web of Science ID A1993KU05800013

    View details for PubMedID 8478855

  • HEALTH-STATUS AMONG PERSONS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - A COMMUNITY-BASED STUDY MEDICAL CARE Lubeck, D. P., Fries, J. F. 1993; 31 (3): 269-276

    View details for Web of Science ID A1993KU34500008

    View details for PubMedID 8450683

  • THE HIERARCHY OF OUTCOME ASSESSMENT JOURNAL OF RHEUMATOLOGY Fries, J. F. 1993; 20 (3): 546-547

    View details for Web of Science ID A1993KU05800030

    View details for PubMedID 8478869

  • THE RELATIVE TOXICITY OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS ARTHRITIS AND RHEUMATISM Fries, J. F., WILLIAMS, C. A., Ramey, D., Bloch, D. A. 1993; 36 (3): 297-306

    Abstract

    To compare the toxicities of commonly employed disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA).Toxicity Index scores, computed from symptoms, laboratory abnormalities, and hospitalizations attributable to DMARD therapy, were assessed in 2,747 patients with RA receiving 3,053 courses of 6 DMARDs and 1,309 courses of prednisone over 7,278 patient-years. Results were adjusted for severity of illness and other covariates.Least toxic was hydroxychloroquine (mean +/- SEM score 1.38 +/- 0.15), followed by intramuscular gold (2.27 +/- 0.17) and the closely grouped D-penicillamine (3.38 +/- 0.36), methotrexate (3.82 +/- 0.35), and azathioprine (3.92 +/- 0.39). Auranofin (5.25 +/- 0.32) was most toxic, but this toxicity resulted from a high frequency of minor complications. Hospitalizations because of auranofin or hydroxychloroquine therapy were not noted. Prednisone (3.83 +/- 0.39) was of comparable toxicity, although it is likely that not all events of prednisone toxicity were captured. For reference, the toxicity of methotrexate and azathioprine was similar to that of the most toxic nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin 3.99, tolmetin sodium 3.96, and meclofenamate 3.86). Hydroxychloroquine showed less toxicity than the most commonly used prescription NSAIDs.There are substantial differences in toxicity among DMARDs and less important differences in toxicity between specific DMARDs and specific NSAIDs.

    View details for Web of Science ID A1993KR79800002

    View details for PubMedID 8452574

  • THE RISK OF OSTEOARTHRITIS WITH RUNNING AND AGING - A 5-YEAR LONGITUDINAL-STUDY JOURNAL OF RHEUMATOLOGY Lane, N. E., Michel, B., BJORKENGREN, A., Oehlert, J., Shi, H., Bloch, D. A., Fries, J. F. 1993; 20 (3): 461-468

    Abstract

    Our purpose was to determine the 5-year longitudinal effects of running and aging on the development of radiographic and clinical osteoarthritis (OA) of the knees, hands and lumbar spine. Thirty-five running subjects and 38 controls, with a mean age of 63 years, were matched for age (+/- 2 years), years of education, and occupation; 33 matched pairs were constructed. All subjects underwent rheumatologic examination, completed questionnaires, and had radiographs taken of the hands, lateral lumbar spine, and knees in 1984 and in 1989. Five year radiographic results for both the runner and control groups showed OA progression for the knees, hands, and lumbar spine. In 1989, 10 (13%) of the 73 subjects fit American College of Rheumatology (ACR) criteria for clinical OA of the hand, and 9 subjects (12%) fit ACR criteria for OA of the knee. In summary, running did not accelerate the development of radiographic or clinical OA of the knees, but with aging, 13% of all subjects developed OA of the hands and 12% of all subjects developed OA of the knees.

    View details for Web of Science ID A1993KU05800010

    View details for PubMedID 8478853

  • ASSOCIATIONS AMONG HEALTHY HABITS, AGE, GENDER, AND EDUCATION IN A SAMPLE OF RETIREES INTERNATIONAL JOURNAL OF AGING & HUMAN DEVELOPMENT Leigh, J. P., Fries, J. F. 1993; 36 (2): 139-155
  • THE CHRONIC DISEASE DATA-BANK MODEL - A CONCEPTUAL-FRAMEWORK FOR THE COMPUTER-BASED MEDICAL RECORD COMPUTERS AND BIOMEDICAL RESEARCH Fries, J. F. 1992; 25 (6): 586-601

    Abstract

    The principles underlying the chronic disease data bank model are straight-forward: (1) the purpose of medical care is to improve patient outcomes; (2) patient outcomes in contemporary developed societies are overwhelmingly linked to chronic illnesses and degenerative processes and will become increasingly so; (3) such outcomes have multiple determinants including the psychological and social, as well as the biologic; (4) outcome antecedents (risk factors) may precede clinical illness by years or decades; and (5) these complex characteristics require for their study (a) computer aid and (b) longitudinal data. The chronic disease data bank provides an important resource, available to many investigators, for examination of the complex set of clinical and policy questions arising with long-term illness and addressing the questions of lifetime health. The chronic disease data bank consecutively enrolls eligible subjects, follows them for life, and amasses time-oriented, multidisciplinary data including clinical findings, medical history, demographics, treatments, resource utilization and disease outcomes, and assessing both the quality of life and its duration. Analyses are longitudinal and time-series in type, examining changes in trends and tempo of the disease, and are focused upon long-term outcomes. Outcomes are regularly and carefully assessed, and include the outcome dimensions of death, disability, discomfort, iatrogenic toxicity, and dollar cost. Specific studies address the description of the disease from biologic, demographic, economic, and social viewpoints, identify the factors associated with good and bad outcomes, and assess the effects of treatment, both good and ill. The clinical and policy goals are focused upon delaying transitions from more benign disease states to more serious ones, thus improving both longevity and the quality of life. The time is appropriate to consider generalization of the chronic disease data bank model to the usual clinical care situation, with large rewards in improvement of the quality of care. The traditional medical record lacks systematic documentation of end results and of important covariates related to health risks. As such, it cannot readily be used to assess the ultimate quality of care and to establish a feedback loop to change behaviors and thereby improve outcomes. It is weak where the chronic disease data bank is strong. The technology is transferable.

    View details for Web of Science ID A1992KB00700007

    View details for PubMedID 1458861

  • Changes in quality of life among persons with HIV infection. Quality of life research Lubeck, D. P., Fries, J. F. 1992; 1 (6): 359-366

    Abstract

    Health-related quality of life (QOL) is an important component of the evaluation of patient outcome in HIV infection where disease is progressive and debilitating. This paper compares patient-reported QOL obtained from questionnaires which cover functional ability, social functioning, cognition, mental health, disability days, disease symptoms, and overall health in the previous 3 months. These scales have been validated on HIV populations. We compared changes in health status over 12 months for 669 patients with varying HIV disease severity: 134 asymptomatic, 416 symptomatic (previously termed ARC), and 119 AIDS. Groups were evaluated at baseline for demographic and health status differences (i.e., age, CD4+). Declines in health status and psychosocial status were found over the year for all persons. Individuals with symptomatic disease or AIDS had significant declines of 10-20% (p < 0.001) in all aspects of role functioning (social, daily activities, energy, and global health) and increased disease symptoms, but no significant declines in cognition or mental health. Persons with AIDS had greater declines than those with symptomatic disease. AIDS and symptomatic patients also reported significantly fewer hours at work and more disability days than asymptomatic patients. The impact that HIV disease has on the health status of non-AIDS symptomatic patients is especially striking.

    View details for PubMedID 1299468

  • SEVERITY OF DISABILITY AND DURATION OF DISEASE IN RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Leigh, J. P., Fries, J. F., Parikh, N. 1992; 19 (12): 1906-1911

    Abstract

    A longitudinal sample of patients with rheumatoid arthritis (RA) from Santa Clara County, CA was analyzed. Severity was measured with the Disability Index from the Health Assessment Questionnaire (HAQ). First, 6 cohorts were created of women and men with 0 to 10, > 10 to 20, and > 20 years of duration of illness in 1981. Experiences of the 6 cohorts were studied from 1981 to 1989. For both sexes, and both samples which alternately included and excluded the deceased, persons with > 20 years of duration experienced faster deterioration than those with < 20 years. Second, multiple regression models were estimated which treated the Disability Index as the dependent variable. In the regression models, the Disability Index worsened more quickly for women than men, for persons with few rather than many years of education, and for older than younger persons. Regression models which excluded an intercept term suggested a unique "S" shaped curve that described the Disability Index and duration relation.

    View details for Web of Science ID A1992KD89900012

    View details for PubMedID 1294738

  • IMPACT OF RUNNING ON LUMBAR BONE-DENSITY - A 5-YEAR LONGITUDINAL-STUDY JOURNAL OF RHEUMATOLOGY Michel, B. A., Lane, N. E., BJORKENGREN, A., Bloch, D. A., Fries, J. F. 1992; 19 (11): 1759-1763

    Abstract

    Our study was designed to examine associations of longterm physical impact (running) with changes in lumbar bone mineralization. Study subjects were a volunteer sample of 14 members of a running club now aged 55 to 77 years and 14 matched controls undergoing computerized scans of the first lumbar vertebra both at baseline and after 5 years. Separate analyses included data from 23 runners available over the entire 5-year period. A decrease in bone mineral density (BMD) over time was statistically significant in both runners and controls. Among runners bone loss was most pronounced in those decreasing their running habits substantially. At the 5-year mark, runners maintained greater BMD. A highly significant correlation was found between change in lumbar BMD and average time spent running (min/week) over the 5-year period. Furthermore, changes in BMD were positively correlated with changes in run min/week. We conclude that regular running appears to reduce age related bone loss both in women and men over 50 years of age. However, substantial decreases in physical weight bearing activity are associated with important bone loss in the lumbar spine.

    View details for Web of Science ID A1992JY69000022

    View details for PubMedID 1491398

  • DISABILITY IN OCCUPATIONS IN A NATIONAL SAMPLE AMERICAN JOURNAL OF PUBLIC HEALTH Leigh, J. P., Fries, J. F. 1992; 82 (11): 1517-1524

    Abstract

    We sought to develop lists of jobs whose members reported high and low levels of functional disability.Samples of women (n = 6096) and men (n = 3653) were drawn from the National Health and Nutrition Examination Survey I Epidemiological Follow-up. Disability was measured with a modified Stanford Health Assessment Questionnaire. We analyzed women and men separately, and we calculated average disability indices within longest-held occupations while adjusting for age, age-squared, married spouse present, and education. We minimized attrition bias with an econometric technique.From highest to lowest association with disability, the female broad occupations ranking was as follows: farming, no occupation, laborers, service, technicians, operatives, crafts workers, transportation operators, professionals, sales workers, administrative support, and managers. The male broad occupations ranking was as follows: no occupation, farming, operatives, crafts workers, service, technicians, manager, administrative support, sales, and professionals. The highest levels of disability for women and men occurred among nonconstruction laborers, farm workers, twisting machine operators, servants, machinery maintenance workers, mining machine operators, and bus drivers.Our results suggest that, in understanding levels of functional disability, occupational safety and health play a larger role than is generally assumed.

    View details for Web of Science ID A1992JW90200014

    View details for PubMedID 1443303

  • PHOTOPHERESIS FOR SCLERODERMA - NO JOURNAL OF RHEUMATOLOGY Fries, J. F., Seibold, J. R., Medsger, T. A. 1992; 19 (7): 1011-1012

    View details for Web of Science ID A1992JD69400001

    View details for PubMedID 1512753

  • STRATEGIES FOR REDUCTION OF MORBIDITY AMERICAN JOURNAL OF CLINICAL NUTRITION Fries, J. F. 1992; 55 (6): S1257-S1262
  • Strategies for reduction of morbidity. American journal of clinical nutrition Fries, J. F. 1992; 55 (6): 1257S-1262S

    Abstract

    The future health of our increasingly senior populations depend upon the interrelationship between two critical points: the onset time of the first major disease, infirmity, or disability and the time of death. Reduction of morbidity requires compressing the average period between these points and reducing the average level of morbidity during this period. The goal of compression of morbidity currently is being achieved in some areas. Life expectancy increases in the United States above age 65 y have plateaued, with further increases becoming ever more difficult. Some major chronic diseases, such as atherosclerosis and lung cancer, now occur later in life. Work disability prevalence has begun to decline. Intergenerational comparisons demonstrate improved health at specific ages. Randomized-controlled trials of primary prevention have failed to decrease total mortality in risk subjects while markedly decreasing the morbidity experienced by the same subjects. Compression has been documented for higher socioeconomic class subpopulations. These observations have major implications for health policy and mandate initiatives directed at prevention of disability and infirmity.

    View details for PubMedID 1534198

  • GENDER AND RACE DIFFERENCES IN THE CORRELATION BETWEEN BODY-MASS AND EDUCATION IN THE 1971-1975 NHANES-I JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Leigh, J. P., Fries, J. F., Hubert, H. B. 1992; 46 (3): 191-196

    Abstract

    Differences in the correlation between body mass index and education across four gender and race groups were investigated while simultaneously accounting for occupation, income, marital status, and age.The study used analysis of covariance techniques to calculate average body mass and confidence intervals within education categories while simultaneously adjusting for the covariates: age, square of age, family income, marital status, and occupation.Data were drawn from the US National Health and Nutrition Examination Survey (NHANES I), 1971-1975. NHANES I is a national probability sample designed to gather information on the non-institutionalised US civilians, ages 1-74 years.Samples of 8211 white women, 1673 black women, 6188 white men, and 1023 black men were drawn from the NHANES I, 1971-1975.Data in the female samples indicate a strictly inverse relation between body mass and years of schooling among white women and an inverted "U" association among black women, achieving a maximum around 8 to 11 years of schooling. In the male samples data indicate inverted "U" relations among both black and white men, reaching maxima between 12 and 15 years of schooling. The sides of the "U" curve are much steeper for black than for white men.The four gender/race categories display four different body mass index and education associations. These four associations are only slightly altered by simultaneously adjusting for two additional measures of socioeconomic status: occupation and income.

    View details for Web of Science ID A1992HY56800006

    View details for PubMedID 1645069

  • RANDOMIZED CONTROLLED-STUDY OF A RETIREE HEALTH PROMOTION PROGRAM - THE BANK-OF-AMERICA STUDY ARCHIVES OF INTERNAL MEDICINE Leigh, J. P., Richardson, N., Beck, R., Kerr, C., Harrington, H., PARCELL, C. L., Fries, J. F. 1992; 152 (6): 1201-1206

    Abstract

    The initial results of a 12-month controlled trial of a health promotion program in 5686 Bank of America retirees, randomized into full program, questionnaire only, and insurance claims only groups, were analyzed to determine whether the health promotion program was effective. Comparisons were between program and questionnaire only groups for self-reported health habit changes, health risk scores, medical care utilization, and days confined to home, and between all groups for insurance claims data. The intervention, or full program, included health habit questionnaires administered every 6 months, individualized time-oriented health risk appraisals, personal recommendation letters, self-management materials, and a health promotion book. Twelve-month changes in health habits, health status, and economic variables favored the full program group in 31 of 32 comparisons and were statistically significant at the .05 level in two-tailed tests in 19 comparisons and at the .01 level in two-tailed tests in 13 comparisons. Over 12 months, overall computed health risk scores decreased by 4.3% in the full program experimental group and increased by 7.2% in the questionnaire only control group. Total direct and indirect costs decreased by 11% in the experimental group and increased by 6.3% in the questionnaire only control group. Analysis of claims data confirmed these trends. A low-cost health promotion program for retirees was effective in changing health behaviors and has potential to decrease health care utilization.

    View details for Web of Science ID A1992HY95700010

    View details for PubMedID 1599348

  • PREDICTORS OF DISABILITY IN A LONGITUDINAL SAMPLE OF PATIENTS WITH RHEUMATOID-ARTHRITIS ANNALS OF THE RHEUMATIC DISEASES Leigh, J. P., Fries, J. F. 1992; 51 (5): 581-587

    Abstract

    Information from the Health Assessment Questionnaire (HAQ) is used to identify which variables measured in 1981 successfully predict the severity of disease in 1989 and the eight year change in severity of disease in a sample of 330 residents of Santa Clara County, California, USA. This study is exploratory and no previous hypotheses are made. Using univariate correlations and stepwise linear regressions, initial values of a number of variables are found to be useful predictors including, in order: the HAQ disability index, pain scale, global health status, tender joints, few work hours, age, female sex, never married, widowhood, and occupation as operative (e.g. dry wall installers, assemblers). Data suggest that deterioration over eight years is least rapid for those with severe disease in 1981. A mathematical identity suggests that analyses of the changes in severity versus analyses of 1989 severity are identical, provided that the 1981 disability index is entered as a covariate. The initial level of the disability index of the HAQ is by far the strongest predictive variable and provides a clinically important gauge for the likelihood of future impairment.

    View details for Web of Science ID A1992HR15000002

    View details for PubMedID 1535493

  • Health risk changes with a low-cost individualized health promotion program: effects at up to 30 months. American journal of health promotion Fries, J. F., Fries, S. T., PARCELL, C. L., Harrington, H. 1992; 6 (5): 364-371

    Abstract

    Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials.We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period.Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p less than .0001) in those 65 and over and 18.4% (p<.0001) in those under 65. At 30 months, improvement was 18.8% (p less than .0001) and 25.7% (p less than .0001), respectively. There was improvement in self-report scores for all targeted health risk behaviors, except for pounds over ideal weight, including smoking; dietary fat, salt, and fiber; alcohol; exercise; cholesterol; and reported stress. There was progressive improvement approximating 5% each six-month period. Results were consistent across age groups 16-35, 36-50, 51-65, and over 65 and over different educational level. Results could not be accounted for by sequential changes in initial health habits of participants over time.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for PubMedID 10148757

  • Health status instruments and physical examination techniques in clinical measurement methodologies. Current opinion in rheumatology Clarke, A. E., Fries, J. F. 1992; 4 (2): 145-152

    Abstract

    Chronic rheumatic diseases can severely compromise a patient's functional ability. These limitations are often better appreciated through a patient's self-report and a physician examination than through laboratory and radiographic assessments. Researchers are adapting the established health status questionnaires for non-English-speaking patients and for other rheumatic conditions besides rheumatoid arthritis. Rather than tailoring existing instruments for other diseases, some clinician investigators are developing entirely new disease-specific self-assessment questionnaires. Physicians are also addressing the subjectivity of their physical examination techniques. They are devising consistent and sensitive parameters that can be combined with health status questionnaires to monitor disease activity, gauge therapeutics, predict health services utilization, and predict work disability.

    View details for PubMedID 1581141

  • HEALTH HABITS, HEALTH-CARE USE AND COSTS IN SAMPLE OF RETIREES INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING Leigh, J. P., Fries, J. F. 1992; 29 (1): 44-54

    Abstract

    Relationships between health habits and subsequent medical costs were analyzed for a group of 1,558 Bank of America retirees followed for 12 months. Results suggest that absence of cigarette smoking, excessive drinking, and excess body mass, and increased exercise and seat belt use were associated with roughly $372 to $598 of direct costs savings and $4,298 of total costs savings per person per year. This study presents what appears to be the first longitudinal data relating health habits to health costs in a senior sample.

    View details for Web of Science ID A1992HP83200007

    View details for PubMedID 1559723

  • THE RELATIVE TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) RHEUMATOLOGY, STATE OF THE ART Fries, J. F., WILLIAMS, C. A., Bloch, D. A. 1992; 984: 322-324
  • Associations among healthy habits, age, gender, and education in a sample of retirees. International journal of aging & human development Leigh, J. P., Fries, J. F. 1992; 36 (2): 139-155

    Abstract

    In this exploratory and descriptive study, data are drawn from a sample of 1,864 Bank of America retirees collected in 1987 to investigate correlations among healthy habits, age, gender, and education. Findings include: 1) Health habits are strongly and positively associated with each other and negatively associated with unhealthy habits. 2) Age is statistically significant and positively associated with fiber, fat consumption, and lack of exercise, but negatively associated with cigarette use. 3) Women are more likely than men to smoke, use seat belts, and eat foods high in fiber. Men are more likely than women to exercise and drink excessively. 4) Education is statistically significant and positively associated only with fiber in the diet and no other habit. 5) Fiber consumption emerges as the healthy habit most consistently associated with all other habits.

    View details for PubMedID 1297635

  • IMPROVEMENT IN INTERGENERATIONAL HEALTH AMERICAN JOURNAL OF PUBLIC HEALTH Fries, J. F., WILLIAMS, C. A., MORFELD, D. 1992; 82 (1): 109-112

    Abstract

    Differences in health status between subjects, their parents, and their children were analyzed in 2206 subjects who had attended the University of Pennsylvania during the 1939 to 1940 school year. Subjects compared their overall health status at the average age of 70 with that of their same-sex parent at the same age and with that of their same-sex child at the approximate average age of 45, providing reasons for reported differences. Thus, health status in family members of the same sex at the same age in 1988 was compared with that in approximately 1963. Subject health was strikingly improved compared with that of their parents a generation earlier, with 58% reporting their health to be better or much better, and only 9% reporting it to be worse or much worse (P less than .001). The major reasons for the difference were decreased prevalence of chronic conditions and healthier life-styles. The same results were observed in a community-based population of 317 subjects and, even more strikingly, in a group of 422 aging long-distance runners. These observations suggest substantial improvement in senior health status over the past quarter century in selected populations, and they contrast with equivocal changes that have been noted with traditional serial survey techniques.

    View details for Web of Science ID A1992HL39900025

    View details for PubMedID 1536312

  • THE RELATIVE TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ARTHRITIS AND RHEUMATISM Fries, J. F., WILLIAMS, C. A., Bloch, D. A. 1991; 34 (11): 1353-1360

    Abstract

    Toxicity Index scores were computed from symptoms, laboratory abnormalities, and hospitalizations attributed to nonsteroidal antiinflammatory drug (NSAID) therapy in 2,747 patients with rheumatoid arthritis receiving 5,642 courses of 11 NSAIDs over 8,481 patient-years. Substantial differences in overall toxicity were found, the differences between drugs often being clinically significant (2-3 times as toxic) and highly statistically significant. The results strengthened after adjustment for differing patient characteristics, held generally across multiple ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) data bank centers, and persisted after use of different techniques for the weighting of side effects. The most toxic side effects were experienced by patients taking indomethacin (mean +/- SEM score 3.99 +/- 0.58), tolmetin sodium (3.96 +/- 0.74), and meclofenamate sodium (3.86 +/- 0.66). Least toxic were coated or buffered aspirin (1.19 +/- 0.10), salsalate (1.28 +/- 0.34), and ibuprofen (1.94 +/- 0.43). The most toxic drugs were generally taken in the lowest relative doses. There are statistical differences in overall toxicity between different NSAIDs as used in rheumatoid arthritis, and these differences are both clinically and statistically significant.

    View details for Web of Science ID A1991GN25900002

    View details for PubMedID 1953813

  • EFFECT OF CHANGES IN WEIGHT-BEARING EXERCISE ON LUMBAR BONE MASS AFTER AGE 50 ANNALS OF MEDICINE Michel, B. A., Lane, N. E., Bloch, D. A., Jones, H. H., Fries, J. F. 1991; 23 (4): 397-401

    Abstract

    This two year longitudinal study of 40 healthy subjects over age fifty (27 exercisers, 13 non-exercisers) was designed to evaluate the impact of weight-bearing exercise on lumbar bone mineral density as assessed by quantitative computed tomography. In both males and females exercising at moderate levels, a high correlation was found between changes in exercise and changes in bone density (r = 0.78 and 0.91, respectively P less than 0.002). For extreme levels of exercise (greater than 300 min/week in females over age fifty, and greater than 200 min/week in males over age seventy) bone density was low, confirming earlier cross-sectional results. Subjects without change in their exercise levels and non-exercisers lost similar amounts of bone. Increasing body mass index was identified as a protective factor with regard to lumbar bone loss. We conclude that in exercisers continuation of weight-bearing exercise is mandatory to prevent excessive bone loss. Extreme levels of exercise may be detrimental to bone density in subjects over age fifty years.

    View details for Web of Science ID A1991GL13600010

    View details for PubMedID 1930935

  • VARIABLES ASSOCIATED WITH DECREASED SURVIVAL IN SYSTEMIC LUPUS-ERYTHEMATOSUS SEMINARS IN ARTHRITIS AND RHEUMATISM Seleznick, M. J., Fries, J. F. 1991; 21 (2): 73-80

    Abstract

    Fifty-one deaths occurred among 310 patients with systemic lupus erythematosus (SLE) observed for 1,234 patient-years. Twenty-one of 97 entry variables at first clinic visit were associated with an increased risk of mortality. When corrected for multiple comparisons, the only risk factor that retained statistical significance was systolic blood pressure. Each millimeter unit increase in systolic blood pressure corresponded to a 2% increase in mortality risk. Stepwise covariance and recursive partitioning analyses tended to identify nonspecific prognostic variables, rather than the classic serological and diagnostic features of SLE. These data suggest that hypertension is a more significant risk factor for mortality in SLE than the more specific measures of disease severity.

    View details for Web of Science ID A1991GL63300002

    View details for PubMedID 1749941

  • NONSTEROIDAL ANTIINFLAMMATORY DRUG-ASSOCIATED GASTROPATHY - INCIDENCE AND RISK FACTOR MODELS AMERICAN JOURNAL OF MEDICINE Fries, J. F., WILLIAMS, C. A., Bloch, D. A., Michel, B. A. 1991; 91 (3): 213-222

    Abstract

    The most prevalent serious drug toxicity in the United States is increasingly recognized as gastrointestinal (GI) pathology associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The incidence of serious GI events (hospitalization or death) associated with NSAID use was therefore prospectively analyzed in patients with rheumatoid arthritis (RA) and patients with osteoarthritis.The study consisted of 2,747 patients with RA and 1,091 patients with osteoarthritis. The yearly hospitalization incidence during NSAID treatment was 1.58% in RA patients and was similar in all five populations studied. The hazard ratio of patients taking NSAIDs to those not taking NSAIDs was 5.2. The incidence in osteoarthritis may be less. The risk of GI-related death in RA patients was 0.19% per year with NSAIDs. Multivariate analyses assessing risk factors for serious GI events were performed in the 1,694 (98 with an event) RA patients taking NSAIDs at the predictive visit. The main risk factors were higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, level of disability, and NSAID dose. A rule is presented that allows estimation of the risk for the individual patient with RA.Knowledge of the risk factors for NSAID-associated gastropathy and their inter-relationships provides a tool for identification of the patient at high risk and for initiation of appropriate therapeutic action.

    View details for Web of Science ID A1991GG13000002

    View details for PubMedID 1892140

  • MORTALITY PREDICTORS AMONG 263 PATIENTS WITH RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Leigh, J. P., Fries, J. F. 1991; 18 (9): 1307-1312

    Abstract

    A cohort of 263 patients who completed Health Assessment Questionnaires (HAQ) each year from 1981 to 1989 is examined. Forty-three (43) possible covariates measured in 1981 are considered that might help predict mortality over the 8 years of the study. We use univariate correlation coefficients, stepwise regressions, and survival functions to identify a number of covariates that appear useful for predicting survival: age (-), prednisone use (-), disability index (-), male sex (-), never married (-), penicillamine use (+), divorced (+), and no occupation (-). Our results confirm studies suggesting that the HAQ disability index is a useful prognosticator of length of survival.

    View details for Web of Science ID A1991GK15000007

    View details for PubMedID 1757929

  • THE HIERARCHY OF QUALITY-OF-LIFE ASSESSMENT, THE HEALTH ASSESSMENT QUESTIONNAIRE (HAQ), AND ISSUES MANDATING DEVELOPMENT OF A TOXICITY INDEX CONTROLLED CLINICAL TRIALS Fries, J. F. 1991; 12 (4): S106-S117
  • The hierarchy of quality-of-life assessment, the Health Assessment Questionnaire (HAQ), and issues mandating development of a toxicity index. Controlled clinical trials Fries, J. F. 1991; 12 (4): 106S-117S

    Abstract

    Health, as defined by the World Health Organization, encompasses the more redundant and cumbersome phrase "health-related quality of life." Valuations by patients naturally separate this entity into the primary dimensions of absence of death, disability, discomfort, drug toxicity, and destitution. These dimensions separate naturally into subdimensions, and the subdimensions into components, thus providing a hierarchy under which assessment of particular aspects of health may be placed. In the clinical trial situation, it is essential that all dimensions always be assessed and reported, because otherwise, misleading conclusions may be drawn. On the other hand, it is much less important which assessment instrument is chosen, or how much detail is assessed for each dimension. The Health Assessment Questionnaire (HAQ) has been developed under a hierarchical conceptual model and widely used; its characteristics are described. A new index for measurement of drug toxicity has been developed for the HAQ, and its crucial role in comparing treatments in a clinical trial discussed. Issues in reliably describing comparative drug toxicity are developed, a toxicity index presented, and some preliminary results and conclusions outlined. With the ability to quantitatively describe drug toxicity, health assessment becomes conceptually more complete.

    View details for PubMedID 1663848

  • OCCUPATION, INCOME, AND EDUCATION AS INDEPENDENT COVARIATES OF ARTHRITIS IN 4 NATIONAL PROBABILITY SAMPLES ARTHRITIS AND RHEUMATISM Leigh, J. P., Fries, J. F. 1991; 34 (8): 984-995

    Abstract

    The strong associations between education level and prevalence and severity of arthritis have recently been investigated, with some suggestion that the relationships might be causal. Data from 4 national probability samples were analyzed, in which occupation and income were measured currently and prior to the development of arthritis. These data indicate that previous studies overestimated the strength of the association between schooling and arthritis because income and, especially, occupation were not analyzed as separate covariates. The overestimate appears to be especially high for persons currently employed, for men, and for persons employed in dangerous jobs. Health policy strategies directed toward reducing arthritis rates require not simply a focus on education, but the additional socioeconomic status dimensions of income and occupational safety and health.

    View details for Web of Science ID A1991GA98800007

    View details for PubMedID 1859493

  • PROPHYLAXIS OF NONSTEROIDAL ANTIINFLAMMATORY DRUG GASTROPATHY - A CLINICAL OPINION JOURNAL OF RHEUMATOLOGY Roth, S. H., Fries, J. F., ABADI, I. A., Hubscher, O., Mintz, G., Samara, A. M. 1991; 18 (7): 956-958

    View details for Web of Science ID A1991FY15900003

    View details for PubMedID 1920327

  • PREDICTORS OF FRACTURES IN EARLY RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Michel, B. A., Bloch, D. A., Fries, J. F. 1991; 18 (6): 804-808

    Abstract

    Three hundred ninety-five patients with rheumatoid arthritis (mean age 49 years) were followed for an average of 6.7 years, and their baseline variables from the initial visit were examined for prediction of time to first fracture. Multivariate analyses identified use of corticosteroids in women and prior diagnosis of osteoporosis as important risk factors. Among patients taking 5 mg or more of prednisone, female sex strongly predicted fractures: the 5-year probability of having a fracture was 34%. Low risk groups were nonosteoporotic and consisted of men and patients taking less than 5 mg prednisone.

    View details for Web of Science ID A1991FU45400005

    View details for PubMedID 1895260

  • NSAID GASTROPATHY - THE 2ND MOST DEADLY RHEUMATIC DISEASE - EPIDEMIOLOGY AND RISK APPRAISAL JOURNAL OF RHEUMATOLOGY Fries, J. F. 1991; 18: 6-10
  • NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal. journal of rheumatology. Supplement Fries, J. F. 1991; 28: 6-10

    Abstract

    Nonsteroidal antiinflammatory drug (NSAID) gastrointestinal (GI) pathology (gastropathy) accounts for over 70,000 hospitalizations and over 7,000 deaths annually in the United States. Not all patients, however, are at equal risk. Major risk factors for serious events (hospitalization or death) in patients with rheumatoid arthritis (RA) are age, level of disability, concurrent use of prednisone, prior NSAID side effects and NSAID dose. For the average patient with RA, the chance of hospitalization or death due to a GI event is about 1.3 to 1.6% over the course of 12 months and about 1 in 3 over the entire course of the disease. Subgroups of patients have risks ranging from nearly zero to as high as 4 or 5%/years. A simple scoring system based on multivariate analysis of risk factors permits the clinician to directly calculate the risk for the individual patient.

    View details for PubMedID 2038014

  • TOXICITY PROFILES OF DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Singh, G., Fries, J. F., WILLIAMS, C. A., Zatarain, E., Spitz, P., Bloch, D. A. 1991; 18 (2): 188-194

    Abstract

    The toxicity profiles of 7 disease modifying antirheumatic drugs (DMARD) (hydroxychloroquine, intramuscular (im) gold, D-penicillamine, oral gold, methotrexate (MTX), azathioprine and cyclophosphamide) were evaluated in 2,479 patients with rheumatoid arthritis consecutively enrolled at 5 centers in the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) program. Incidence rates for side effects are reported as events/1000 patient-years. Our descriptive study revealed an individual profile of prevalent toxicities for each drug. Oral gold was characterized by substantial lower gastrointestinal (GI) toxicity (diarrhea 391 events/1000 patient-years, loose bowel movement 148, lower abdominal pain 76), MTX by hepatotoxicity (47) while D-penicillamine had the only clinically significant incidence of altered taste (40). MTX users reported the most mucosal ulcers (87), followed by oral gold (76), im gold (55) and D-penicillamine (38). Rash was frequently seen with gold compounds and D-penicillamine, while upper GI toxicity was common with immunosuppressive agents. Cyclophosphamide had 48% discontinuations within 6 months. MTX had the lowest discontinuation rate in the first 6 months, but then showed little difference from im gold. A preliminary similarity index was developed to compare the toxicity profiles of various DMARD. Close similarities were found between toxicity profiles of im gold and D-penicillamine, and between azathioprine and MTX. Oral gold had a unique toxicity pattern. Knowledge of these different toxicity patterns can enable more appropriate selection of agents for particular patients.

    View details for Web of Science ID A1991EZ83100008

    View details for PubMedID 1673721

  • EVALUATION OF DIAGNOSTIC (CLASSIFICATION) CRITERIA IN BEHCETS-DISEASE - TOWARD INTERNATIONALLY AGREED CRITERIA BEHCETS DISEASE Wechsler, B., Davatchi, F., Mizushima, Y., Hamza, M., Dilsen, N., Kansu, E., Yazici, H., Barnes, C. G., Chamberlain, M. A., James, D. G., Lehner, T., ODUFFY, J. D., Silman, A. J., Gregory, J., Rigby, A. S., Fries, J. 1991; 8: 11-39
  • EDUCATION LEVEL AND RHEUMATOID-ARTHRITIS - EVIDENCE FROM 5 DATA CENTERS JOURNAL OF RHEUMATOLOGY Leigh, J. P., Fries, J. F. 1991; 18 (1): 24-34

    Abstract

    Data on 2,006 patients with rheumatoid arthritis (RA) for 1984 and 1986 were analyzed from 5 American Rheumatism Association Medical Information Systems patient centers to assess covariates of future disability. The dependent variable was the Health Assessment Questionnaire disability index, measured in 1986. Independent variables, measured in 1984, include years of schooling, age, age squared, sex, labor force status, occupation, marital status, race, income, sedimentation rate, log latex, number of tender joints, and duration of illness. A negative association between schooling and the disability index is strongly apparent for men and weaker in women. Results for men persist even after adjustment for occupation and income, but not after additional adjustment for biological variables. The effects of schooling upon progression of RA are complex and interpretation requires simultaneous assessment of a variety of other variables. Causal effects of level of schooling are seen with a social science perspective which considers the biologic data to represent dependent variables yet cannot be inferred from a clinical model which considers the biology of the disease as an independent variable.

    View details for Web of Science ID A1991EW17500006

    View details for PubMedID 2023195

  • SAFETY ISSUES RELATED TO DMARD THERAPY JOURNAL OF RHEUMATOLOGY Fries, J. F. 1990; 17: 14-17
  • Safety issues related to DMARD therapy. journal of rheumatology. Supplement Fries, J. F. 1990; 25: 14-17

    Abstract

    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.

    View details for PubMedID 2273518

  • ASPIRIN, HYDROXYCHLOROQUINE, AND HEPATIC ENZYME ABNORMALITIES WITH METHOTREXATE IN RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Fries, J. F., Singh, G., Lenert, L., Furst, D. E. 1990; 33 (11): 1611-1619

    Abstract

    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.

    View details for Web of Science ID A1990EJ79900002

    View details for PubMedID 2242059

  • THE AMERICAN-COLLEGE-OF-RHEUMATOLOGY 1990 CRITERIA FOR THE CLASSIFICATION OF VASCULITIS - PATIENTS AND METHODS ARTHRITIS AND RHEUMATISM Bloch, D. A., Michel, B. A., Hunder, G. G., MCSHANE, D. J., Arend, W. P., Calabrese, L. H., Edworthy, S. M., Fauci, A. S., Fries, J. F., Leavitt, R. Y., Lie, J. T., LIGHTFOOT, R. W., Masi, A. T., Mills, J. A., Stevens, M. B., Wallace, S. L., Zvaifler, N. J. 1990; 33 (8): 1068-1073

    Abstract

    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.

    View details for Web of Science ID A1990DV71700002

    View details for PubMedID 2202306

  • THE AMERICAN-COLLEGE-OF-RHEUMATOLOGY 1990 CRITERIA FOR THE CLASSIFICATION OF VASCULITIS - SUMMARY ARTHRITIS AND RHEUMATISM Fries, J. F., Hunder, G. G., Bloch, D. A., Michel, B. A., Arend, W. P., Calabrese, L. H., Fauci, A. S., Leavitt, R. Y., Lie, J. T., LIGHTFOOT, R. W., Masi, A. T., MCSHANE, D. J., Mills, J. A., Stevens, M. B., Wallace, S. L., Zvaifler, N. J. 1990; 33 (8): 1135-1136

    View details for Web of Science ID A1990DV71700011

    View details for PubMedID 2202312

  • THE SUNNY SIDE OF AGING JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Fries, J. F. 1990; 263 (17): 2354-2355

    View details for Web of Science ID A1990DB07500040

    View details for PubMedID 2109106

  • REEVALUATING THE THERAPEUTIC APPROACH TO RHEUMATOID-ARTHRITIS - THE SAWTOOTH STRATEGY JOURNAL OF RHEUMATOLOGY Fries, J. F. 1990; 17: 12-15
  • RUNNING, OSTEOARTHRITIS, AND BONE-DENSITY - INITIAL 2-YEAR LONGITUDINAL-STUDY AMERICAN JOURNAL OF MEDICINE Lane, N. E., Bloch, D. A., Hubert, H. B., Jones, H., SIMPSON, U., Fries, J. F. 1990; 88 (5): 452-459

    Abstract

    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.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.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.With the possible exception of spur formation in women, running did not appear to influence the development of radiologic osteoarthritis in the populations studied.

    View details for Web of Science ID A1990DC71600002

    View details for PubMedID 2337104

  • Reevaluating the therapeutic approach to rheumatoid arthritis: the "sawtooth" strategy. journal of rheumatology. Supplement Fries, J. F. 1990; 22: 12-15

    Abstract

    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.

    View details for PubMedID 2192055

  • PLAIN RADIOGRAPHS CAN BE USEFUL IN ESTIMATING LUMBAR BONE-DENSITY JOURNAL OF RHEUMATOLOGY Michel, B. A., Lane, N. E., Jones, H. H., Fries, J. F., Bloch, D. A. 1990; 17 (4): 528-531

    Abstract

    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.

    View details for Web of Science ID A1990DC41300019

    View details for PubMedID 2189996

  • IDENTIFICATION OF PATIENTS AT RISK FOR GASTROPATHY ASSOCIATED WITH NSAID USE JOURNAL OF RHEUMATOLOGY Fries, J. F., Miller, S. R., SPITZ, P. W., WILLIAMS, C. A., Hubert, H. B., Bloch, D. A. 1990; 17: 12-19
  • Identification of patients at risk for gastropathy associated with NSAID use. journal of rheumatology. Supplement Fries, J. F., Miller, S. R., SPITZ, P. W., WILLIAMS, C. A., Hubert, H. B., Bloch, D. A. 1990; 20: 12-19

    Abstract

    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.

    View details for PubMedID 2325051

  • A TOXICITY INDEX FOR COMPARISON OF SIDE-EFFECTS AMONG DIFFERENT DRUGS ARTHRITIS AND RHEUMATISM Fries, J. F., SPITZ, P. W., WILLIAMS, C. A., Bloch, D. A., Singh, G., Hubert, H. B. 1990; 33 (1): 121-130

    View details for Web of Science ID A1990CL04700017

    View details for PubMedID 2302262

  • WEIGHT-BEARING EXERCISE, OVER-EXERCISE, AND LUMBAR BONE-DENSITY OVER AGE 50 YEARS ARCHIVES OF INTERNAL MEDICINE Michel, B. A., Bloch, D. A., Fries, J. F. 1989; 149 (10): 2325-2329

    Abstract

    This cross-sectional study of 78 healthy subjects older than age 50 years was designed to examine the association between weight-bearing exercise and lumbar bone mineral content as assessed by quantitative computed tomography. In women, a strong correlation existed between bone density and the amount of exercise for up to 300 min/wk. However, 5 of 28 women exercising 300 min/wk or more had surprisingly low bone density, not explained by other factors. In 50 men, we also found a strong positive correlation between exercise and bone density for those up to age 65 years. Over age 65, 3 men had low bone density despite extremely vigorous exercise. We conclude that moderate weight-bearing exercise may increase lumbar bone density, but we raise the hypothesis that extremely vigorous exercise actually may be detrimental to bone density in individuals after age 50.

    View details for Web of Science ID A1989AU93500026

    View details for PubMedID 2802897

  • PREDISPOSING FACTORS IN POLYMYOSITIS-DERMATOMYOSITIS - RESULTS OF A NATIONWIDE SURVEY JOURNAL OF RHEUMATOLOGY LYON, M. G., Bloch, D. A., HOLLAK, B., Fries, J. F. 1989; 16 (9): 1218-1224

    Abstract

    Utilizing case-control methods, we surveyed 322 persons who experienced the onset of polymyositis-dermatomyositis (PM-DM) during calendar years 1985 and 1986, in an effort both to test specific hypotheses, and to generate new hypotheses regarding antecedent risk associations for the disease. Data obtained by recall of events during the 12 months before disease onset in cases, and an identical time period in sex matched sibling controls, suggest that important questions for further study include the roles of antecedent heavy muscular exertion and emotional stress as risk factors for PM-DM. Furthermore, it appears that vaccinations, toxic exposures and symptoms of allergic phenomena, throat infection, and upper respiratory infection are either neutral or are negatively associated with risk of PM-DM, findings which also raise important new etiologic questions, or perhaps lay old ones to rest. Malignancy was infrequently noted.

    View details for Web of Science ID A1989AV08900011

    View details for PubMedID 2810279

  • THE NATURAL-HISTORY OF ANKYLOSING-SPONDYLITIS - IS THE DISEASE REALLY CHANGING JOURNAL OF RHEUMATOLOGY Fries, J. F., Singh, G., Bloch, D. A., Calin, A. 1989; 16 (7): 860-863

    View details for Web of Science ID A1989AK77000002

    View details for PubMedID 2788741

  • TOXIC EFFECTS OF AZATHIOPRINE IN RHEUMATOID-ARTHRITIS - A NATIONAL POST-MARKETING PERSPECTIVE ARTHRITIS AND RHEUMATISM Singh, G., Fries, J. F., Spitz, P., WILLIAMS, C. A. 1989; 32 (7): 837-843

    Abstract

    Concerns about the short-term and long-term toxic effects of azathioprine (AZA) have limited its use. Accordingly, we surveyed 393 AZA-treated rheumatoid arthritis (RA) patients, who were recruited and enrolled through a nationwide call to rheumatologists. Findings in these patients were compared with the findings, retrieved from the databank of the American Rheumatism Association Medical Information System, on 153 similarly treated RA patients. All 546 patients were surveyed prospectively, using the Health Assessment Questionnaire and information abstracted from hospital records. The 2 groups were closely similar in clinical characteristics. The most frequently reported side effects of AZA treatment were nausea, vomiting, and leukopenia. Gastrointestinal intolerance accounted for nearly 60% of therapy interruptions in 95 patients. Of 81 hospitalizations for all causes, only 8 may have been related in part to AZA, and no deaths were attributed to AZA therapy. No lymphomas or leukemias were encountered and the overall frequency of neoplasms was not significantly different from that seen in RA patients receiving conventional therapy. As used in the treatment of RA, AZA has a surprisingly benign profile with relatively few serious therapeutic mishaps.

    View details for Web of Science ID A1989AF65800003

    View details for PubMedID 2751718

  • PREVALENCE AND EXPRESSION OF PHOTOSENSITIVITY IN SYSTEMIC LUPUS-ERYTHEMATOSUS ANNALS OF THE RHEUMATIC DISEASES Wysenbeek, A. J., Block, D. A., Fries, J. F. 1989; 48 (6): 461-463

    Abstract

    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.

    View details for Web of Science ID A1989AA37000004

    View details for PubMedID 2742401

  • ADVANCES IN MANAGEMENT OF RHEUMATIC DISEASE - 1965 TO 1985 ARCHIVES OF INTERNAL MEDICINE Fries, J. F. 1989; 149 (5): 1002-1011

    Abstract

    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.

    View details for Web of Science ID A1989U603000002

    View details for PubMedID 2655541

  • OSTEO-ARTHRITIS IN THE HAND - A COMPARISON OF HANDEDNESS AND HAND USE JOURNAL OF RHEUMATOLOGY Lane, N. E., Bloch, D. A., Jones, H. H., SIMPSON, U., Fries, J. F. 1989; 16 (5): 637-642

    Abstract

    Osteoarthritis (OA) of the hand has been suggested to be the result of "wear" and "tear." If so, OA should develop more frequently in the dominant hand. We compared dominant with nondominant hands of 134 consecutive community subjects aged 53-75 by questionnaire, radiographs of hands, and rheumatologic evaluation. Mean age was 60 years, 93% were right handed, and 95% were in occupations classified as nonphysical. Subjects estimated dominant hand use of 2-10 times the amount of the nondominant hand. OA was found in 133 of 134 subjects. No radiologic or clinical differences were found between the dominant and nondominant hands. Twenty-six subjects who self-reported heavier lifetime hand use had somewhat greater clinical and hand radiographic OA scores than the 36 subjects reporting lighter hand use (43.5 vs 34.5) (p less than 0.01). In our study population, OA was not more prevalent in the dominant hand.

    View details for Web of Science ID A1989AA47100017

    View details for PubMedID 2754667

  • HEALTH PROMOTION AND THE COMPRESSION OF MORBIDITY LANCET Fries, J. F., Green, L. W., LEVINE, S. 1989; 1 (8636): 481-483

    View details for Web of Science ID A1989T487700012

    View details for PubMedID 2563849

  • TOWARD AN EPIDEMIOLOGY OF GASTROPATHY ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUG-USE GASTROENTEROLOGY Fries, J. F., Miller, S. R., SPITZ, P. W., WILLIAMS, C. A., Hubert, H. B., Bloch, D. A. 1989; 96 (2): 647-655

    Abstract

    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.

    View details for Web of Science ID A1989T033900012

    View details for PubMedID 2909442

  • A STATE MODEL OF RENAL-FUNCTION IN SYSTEMIC LUPUS-ERYTHEMATOSUS - ITS VALUE IN THE PREDICTION OF OUTCOME IN 292 PATIENTS JOURNAL OF RHEUMATOLOGY Edworthy, S. M., Bloch, D. A., MCSHANE, D. J., Segal, M. R., Fries, J. F. 1989; 16 (1): 29-35

    Abstract

    We defined a clinical staging of renal function in systemic lupus erythematosus (SLE) which uses inexpensive outpatient measures to serially stage patient status and then analyzed the disease course of 292 patients followed since 1968. The 4 mutually exclusive states used were (1) normal (creatinine less than 1.2 mg/dl and protein less than 2+ on dipstick); (2) proteinuria alone (creatinine less than 1.2 mg/dl and protein greater than or equal to 2+ on dipstick); (3) moderate filtration dysfunction (creatinine greater than or equal to 1.2 mg/dl and less than 4.0 mg/dl); and (4) severe azotemia (creatinine greater than or equal to 4.0 mg/dl). Duration in each state and subsequent transitions were incorporated in an assessment of outcome. Prognostic variables were found which predicted different outcomes within each of the 4 states. This stratification, based on renal function over time, provides a useful analytical tool for comparing subsets of patients with lupus. We found that serum complement (C3) predicted progression in state 1 and 2 as well as potential responders to therapy in state 3. No improvement was noted for patients in state 4.

    View details for Web of Science ID A1989T170100007

    View details for PubMedID 2716006

  • THE COMPRESSION OF MORBIDITY - NEAR OF FAR MILBANK QUARTERLY Fries, J. F. 1989; 67 (2): 208-232

    Abstract

    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.

    View details for Web of Science ID A1989CX01600002

    View details for PubMedID 2698444

  • THE CLINICAL-VALUE OF THE STANFORD HEALTH ASSESSMENT QUESTIONNAIRE FUNCTIONAL DISABILITY INDEX IN PATIENTS WITH RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Wolfe, F., KLEINHEKSEL, S. M., CATHEY, M. A., Hawley, D. J., SPITZ, P. W., Fries, J. F. 1988; 15 (10): 1480-1488

    Abstract

    We administered the Stanford Health Assessment Questionnaire functional disability questionnaire to a cohort of 400 patients with rheumatoid arthritis (RA) every 6 months during a mean followup of 3.1 years. Simple classification into 3 groups based on Functional Disability Index (FDI) scores (0-1, 1.1-2, 2.1-3) identified patients with increasingly more severe scores for clinical, psychological, and demographic variables; and FDI scores at entry predicted increased inpatient and outpatient utilization of services, and mortality. The FDI provided important and clinically useful current and predictive information regarding RA status, utilization of services, and mortality that was not available through conventional testing. Our data suggest that such information can be easily and inexpensively obtained.

    View details for Web of Science ID A1988Q842800006

    View details for PubMedID 3204597

  • HIERARCHICAL TIME-ORIENTED APPROACHES TO MISSING DATA INFERENCE COMPUTERS AND BIOMEDICAL RESEARCH ALBRIDGE, K. M., Standish, J., Fries, J. F. 1988; 21 (4): 349-366

    Abstract

    In practice clinical data are nearly always incomplete. When confronted with such data, a physician or investigator must make inferences about missing information. Possible strategies for inference include (1) interpolation, (2) extrapolation, (3) repeating the nearest value, (4) repeating the previous value, (5) patient-specific mean values, (6) patient-specific linear regression over time, (7) disease-specific mean values, (8) normal values, and (9) linear regression of correlated co-recorded variables. This study analyzes these strategies in a time-oriented data bank of patients with systemic lupus erythematosus, demonstrating that more accurate inferences of missing data are obtained when (1) strategies are tailored to the characteristics of the individual variable, (2) time-oriented strategies (e.g., interpolation) rather than non-time-oriented strategies (e.g., disease mean) are incorporated, (3) a ranked set of strategies is incorporated in a hierarchical stepwise fashion, and (4) the degree to which missing data are "nonrandomly" missing is assessed to allow estimation of bias. Interpolation is the best single technique with these data while linear regression of correlated co-recorded variables is a relatively weak technique. Inferences made by these hierarchical time-oriented approaches show significantly smaller mean differences from the actual values than do results from typical statistical package strategies.

    View details for Web of Science ID A1988P628700005

    View details for PubMedID 3168432

  • THE CHRONIC DISEASE DATA-BANK - THE ARAMIS EXPERIENCE PROCEEDINGS OF THE IEEE MCSHANE, D. J., Fries, J. F. 1988; 76 (6): 672-679
  • AGING, ILLNESS, AND HEALTH-POLICY - IMPLICATIONS OF THE COMPRESSION OF MORBIDITY PERSPECTIVES IN BIOLOGY AND MEDICINE Fries, J. F. 1988; 31 (3): 407-428

    View details for Web of Science ID A1988N147000009

    View details for PubMedID 3393419

  • POSTMARKETING DRUG SURVEILLANCE - ARE OUR PRIORITIES RIGHT JOURNAL OF RHEUMATOLOGY Fries, J. F. 1988; 15 (3): 389-390

    View details for Web of Science ID A1988M927700002

    View details for PubMedID 3379617

  • POSTMARKETING SURVEILLANCE IN RHEUMATOLOGY - ANALYSIS OF PURPURA AND UPPER ABDOMINAL-PAIN JOURNAL OF RHEUMATOLOGY Fries, J. F., Bloch, D. A., Segal, M. R., SPITZ, P. W., Williams, C., Lane, N. E. 1988; 15 (2): 348-355

    Abstract

    A system of postmarketing surveillance of antirheumatic drugs employing prospective protocol based consecutive patient cohorts is described, together with use of recursive partitioning techniques for statistical adjustment for potentially confounding variables. An analysis of 2 side effects (purpura and upper abdominal pain) is presented. Purpura was found to be associated with age, sex, disease duration, and amount of disability. The combination of aspirin and prednisone was associated with the highest prevalence of purpura. Upper abdominal pain also varied across drug classes. Within the nonsteroidal antiinflammatory drug category, there were clinically important differences in the relative prevalence of upper gastrointestinal pain between specific drugs.

    View details for Web of Science ID A1988M422500031

    View details for PubMedID 3361544

  • Relationship of running to osteoarthritis and bone density. Comprehensive therapy Lane, N. E., Fries, J. F. 1988; 14 (2): 7-15

    View details for PubMedID 3278842

  • RADIOGRAPHIC ASSESSMENT OF PROGRESSION IN OSTEOARTHRITIS ARTHRITIS AND RHEUMATISM Altman, R. D., Fries, J. F., Bloch, D. A., Carstens, J., Cooke, D., Genant, H., GOFTON, P., Groth, H., MCSHANE, D. J., Murphy, W. A., Sharp, J. T., Spitz, P., WILLIAMS, C. A., Wolfe, F. 1987; 30 (11): 1214-1225

    Abstract

    We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 12-60 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0-3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.

    View details for Web of Science ID A1987L238800003

    View details for PubMedID 3689459

  • The present and future of comprehensive outcome measures for rheumatic diseases. Clinical rheumatology SPITZ, P. W., Fries, J. F. 1987; 6: 105-111

    Abstract

    In recent years, outcome, or health status, measurement has received wide attention in rheumatology. These measures are based on the concept of maintaining or improving health as the goal of medical care, the World Health Organization (WHO) definition of health, and measurement of those factors that directly impact the patient rather than the traditional measures of disease process. Within this framework, outcomes important to the patient with rheumatic diseases have been identified. They have been conceptualized in general terms of physical, psychological and social functioning or specifically by dimensions of death, disability, discomfort, side effects and economic costs. Two widely used outcome measures, the health assessment questionnaire (HAQ) and the arthritis impact measurement scales (AIMS), are described. Outcomes are measured by patient self-reported questionnaires which have been rigorously tested to establish the measurement properties of reliability and validity. Results show that patient self-report is valid, outcomes are accurately measured, correlate with traditional endpoints, and are sensitive to change over time. These measures are particularly suited for use in follow-up studies because of their simplicity, ease of administration, and cost. Future directions include additional study to define clinically meaningful change, extension of validations to many of the rheumatic diseases, the design of special purpose questionnaires and the development of the cumulative outcome concept.

    View details for PubMedID 3690982

  • DISABILITY IN RHEUMATOID-ARTHRITIS - COMPARISON OF PROGNOSTIC FACTORS ACROSS 3 POPULATIONS JOURNAL OF RHEUMATOLOGY Sherrer, Y. S., Bloch, D. A., MITCHELL, D. M., Roth, S. H., Wolfe, F., Fries, J. F. 1987; 14 (4): 705-709

    Abstract

    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.

    View details for Web of Science ID A1987K037600012

    View details for PubMedID 3668976

  • AGING, LONG-DISTANCE RUNNING, AND THE DEVELOPMENT OF MUSCULOSKELETAL DISABILITY - A CONTROLLED-STUDY AMERICAN JOURNAL OF MEDICINE Lane, N. E., Bloch, D. A., Wood, P. D., Fries, J. F. 1987; 82 (4): 772-780

    Abstract

    Four hundred ninety-eight long-distance runners aged 50 to 72 years were compared with 365 community control subjects to examine associations of repetitive, long-term physical impact (running) with musculoskeletal disability and medical service utilization in a cross-section study. Runners had less physical disability than age-matched control subjects (p less than 0.01) and maintained more functional capacity (p less than 0.001) as measured by a modified Health Assessment Questionnaire Disability Index. Runners sought medical services less often, but one third of the visits that they did make were for running-related injuries. No differences were found between groups in conditions thought to predispose to osteoarthritis and musculoskeletal disability. Ligamentous laxity and family history of arthritis were similar in both groups. Runners demonstrated better cardiovascular fitness and weighed less. Differences persisted after adjustment for age, occupation, and sex, and after inclusion or exclusion of subjects with major medical problems. Musculoskeletal disability appeared to develop with age at a lower rate in runners (0.003 units per year versus 0.028) than in community control subjects, and the decreased rate was observed with both lower extremity and upper extremity functions. These data suggest positive effects of systematic aerobic running activity upon functional aspects of musculoskeletal aging.

    View details for Web of Science ID A1987G855000014

    View details for PubMedID 3551605

  • COMPARATIVE TOXICITY OF TOTAL LYMPHOID IRRADIATION AND IMMUNOSUPPRESSIVE DRUG TREATED PATIENTS WITH INTRACTABLE RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Sherrer, Y., Bloch, D., Strober, S., Fries, J. 1987; 14 (1): 46-51

    Abstract

    Outcomes were compared between consecutive patients who had received either total lymphoid irradiation (TLI) or immunosuppressant treatment for intractable rheumatoid arthritis (RA). There were 33 TLI and 32 immunosuppressive recipients; all patients had failed standard therapy. Average followup from the start of therapy was 2.7 years for TLI and 5.9 years for immunosuppressive recipients. Final disability levels were the same in both groups; mortality was equal in both groups as well. There were more hospitalizations for infections in the TLI group and the infecting organisms tended to be staphylococcus or gram negative organisms. Apart from infections, there were more adverse effects reported in the immunosuppressive therapy group.

    View details for Web of Science ID A1987G460700013

    View details for PubMedID 3572934

  • METHODOLOGY OF VALIDATION OF CRITERIA FOR SLE SCANDINAVIAN JOURNAL OF RHEUMATOLOGY Fries, J. F. 1987: 25-30

    Abstract

    The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunological knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody (FANA) and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity. Development of criteria sets is inherently circular, since the standard of evaluation must consist of the clinical diagnosis. Validation of the diagnosis over time can reduce but not eliminate the circularity. Selection of controls also influences sensitivity and specificity and, ideally, criteria should be developed with controls who represent particularly difficult problems of discrimination. Because the low "prior probability" of the diagnosis in many populations will result in a large number of false positives, preference in general should be for specificity over sensitivity. The 1982 criteria were developed from 177 patients with SLE and 162 control patients from 18 institutions using the next age-, race- and sex-matched patient seen as the control whenever possible. Results of a training sample were validated against a test sample of patients and against 500 patients from other databanks.

    View details for Web of Science ID A1987L679000004

    View details for PubMedID 3317805

  • ARAMIS (THE AMERICAN-RHEUMATISM-ASSOCIATION MEDICAL INFORMATION-SYSTEM) - A PROTOTYPICAL NATIONAL CHRONIC-DISEASE DATA-BANK WESTERN JOURNAL OF MEDICINE Fries, J. F., MCSHANE, D. J. 1986; 145 (6): 798-804

    Abstract

    ARAMIS is a prototype of a national chronic-disease data-bank system consisting of parallel, longitudinal, clinical data sets from 17 diverse locations; the data describe the courses of thousands of patients with rheumatic disease followed over many years. Chronic-disease data-bank systems include the data themselves, protocols to ensure their quality, computer systems for their manipulation, statistical procedures for analysis and an appropriately skilled staff. Such a data resource facilitates analyzing long-term health outcomes and the factors associated with particular outcomes. Such systems are mandated by the overwhelming prevalence of chronic illness; the variability, complexity and uniqueness of a patient's course; the difficulties of traditional randomized approaches in these areas, and the time span required for studying these problems.

    View details for Web of Science ID A1986F251100006

    View details for PubMedID 3492816

  • SURVIVAL, PROGNOSIS, AND CAUSES OF DEATH IN RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM MITCHELL, D. M., SPITZ, P. W., Young, D. Y., Bloch, D. A., MCSHANE, D. J., Fries, J. F. 1986; 29 (6): 706-714

    Abstract

    The factors associated with mortality were examined in a prospective longitudinal study, over an average of 12 years, with 94% followup of patients diagnosed as having rheumatoid arthritis. Of 805 patients, 233 died during the period of the study. Survivorship of rheumatoid arthritis patients was approximately 50% less than that of population controls. Survivorship was decreased by the traditional demographic variables of greater age and male sex; however, a significant independent effect of variables reflecting disease severity (American Rheumatism Association functional class, rheumatoid factor titer, number of involved joints) was identified by multivariate analysis. Seventy-nine excess deaths (i.e., those that would not have been expected in a control population) were due in part to disease-related causes, to infections, and to gastrointestinal complications of therapy. Treatment with gold or prednisone did not seem to affect survivorship or cause of death, except for the clustering of deaths of patients with vasculitis within the prednisone group. Our findings indicate that rheumatoid arthritis, a chronic disabling disease, is also associated with a major decrease in survivorship.

    View details for Web of Science ID A1986C913700002

    View details for PubMedID 3718563

  • A MULTICENTER STUDY OF HOSPITALIZATION IN RHEUMATOID-ARTHRITIS - FREQUENCY, MEDICAL-SURGICAL ADMISSIONS, AND CHARGES ARTHRITIS AND RHEUMATISM Wolfe, F., KLEINHEKSEL, S. M., SPITZ, P. W., Lubeck, D. P., Fries, J. F., Young, D. Y., Mitchell, D., Roth, S. 1986; 29 (5): 614-619

    Abstract

    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).

    View details for Web of Science ID A1986C604700005

    View details for PubMedID 3718553

  • IMPACT OF SPECIFIC THERAPY UPON RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Fries, J. F., SPITZ, P. W., MITCHELL, D. M., Roth, S. H., Wolfe, F., Bloch, D. A. 1986; 29 (5): 620-627

    Abstract

    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.

    View details for Web of Science ID A1986C604700006

    View details for PubMedID 3718554

  • A MULTICENTER STUDY OF ANNUAL HEALTH-SERVICE UTILIZATION AND COSTS IN RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Lubeck, D. P., SPITZ, P. W., Fries, J. F., Wolfe, F., MITCHELL, D. M., Roth, S. H. 1986; 29 (4): 488-493

    Abstract

    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.

    View details for Web of Science ID A1986C150000005

    View details for PubMedID 3707626

  • A MULTICENTER STUDY OF HOSPITALIZATION IN RHEUMATOID-ARTHRITIS - EFFECT OF HEALTH-CARE SYSTEM, SEVERITY, AND REGIONAL DIFFERENCE JOURNAL OF RHEUMATOLOGY Wolfe, F., KLEINHEKSEL, S. M., SPITZ, P. W., Lubeck, D. P., Fries, J. F., Young, D. Y., MITCHELL, D. M., Roth, S. H. 1986; 13 (2): 277-284

    Abstract

    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.

    View details for Web of Science ID A1986C612000009

    View details for PubMedID 3723493

  • THE DEVELOPMENT OF DISABILITY IN RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM Sherrer, Y. S., Bloch, D. A., MITCHELL, D. M., Young, D. Y., Fries, J. F. 1986; 29 (4): 494-500

    Abstract

    Six hundred eighty-one consecutive patients with rheumatoid arthritis were followed for an average of 11.9 years to identify initial factors that predicted subsequent disability. Of 39 potentially predictive variables obtained at study onset and studied by stepwise regression methods, age was found to be the most powerful single predictor of disability, followed by radiologic grade, sex, and initial functional class. The worst prognosis for disability was found in patients who were older women and who showed radiologic worsening and developed functional impairment early in the disease course. Both disability and radiologic progression of disease were found to develop most rapidly during the first years after disease onset and to assume a slow, nearly linear rate of increase after 10 years. Approximately 10% of patients did not develop significant disability. This study suggests that it is possible to identify, early in the disease course, those patients who are likely to develop severe disability, and that "disease-modifying" therapy might well be initiated earlier in such patients and used consistently throughout the subsequent treatment.

    View details for Web of Science ID A1986C150000006

    View details for PubMedID 3707627

  • LONG-DISTANCE RUNNING, BONE-DENSITY, AND OSTEOARTHRITIS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Lane, N. E., Bloch, D. A., Jones, H. H., Marshall, W. H., Wood, P. D., Fries, J. F. 1986; 255 (9): 1147-1151

    Abstract

    Forty-one long-distance runners aged 50 to 72 years were compared with 41 matched community controls to examine associations of repetitive, long-term physical impact (running) with osteoarthritis and osteoporosis. Roentgenograms of hands, lateral lumbar spine, and knees were assessed without knowledge of running status. A computed tomographic scan of the first lumbar vertebra was performed to quantitate bone mineral content. Runners, both male and female, have approximately 40% more bone mineral than matched controls. Female runners, but not male runners, appear to have somewhat more sclerosis and spur formation in spine and weight-bearing knee x-ray films, but not in hand x-ray films. There were no differences between groups in joint space narrowing, crepitation, joint stability, or symptomatic osteoarthritis. Running is associated with increased bone mineral but not, in this cross-sectional study, with clinical osteoarthritis.

    View details for Web of Science ID A1986A209300019

    View details for PubMedID 3945033

  • ASSESSMENT OF RADIOLOGIC PROGRESSION IN RHEUMATOID-ARTHRITIS - A RANDOMIZED, CONTROLLED TRIAL ARTHRITIS AND RHEUMATISM Fries, J. F., Bloch, D. A., Sharp, J. T., MCSHANE, D. J., Spitz, P., BLUHM, G. B., Forrester, D., Genant, H., GOFTON, P., Richman, S., Weissman, B., Wolfe, F. 1986; 29 (1): 1-9

    Abstract

    Radiologic assessment of progressive joint destruction in rheumatoid arthritis is generally considered to be the ultimate standard for evaluation of treatment. We compared alternative radiologic techniques by performing a randomized, controlled trial in which hand films of rheumatoid arthritis patients were read by several skilled observes. The number of joints evaluated (34 versus 18) was found to make relatively little difference, but the number of readers and their experience level was critical. Films should be read in pairs. Joint space narrowing and erosion scores were shown to contribute independent information. Use of recommended techniques can reduce the number of patients required and, thus, can reduce the cost of a clinical trial by more than half and can substantially increase the sensitivity and efficiency of a trial. Therefore, critical selection of the method of assessing study endpoint is of great importance.

    View details for Web of Science ID A1986C133500001

    View details for PubMedID 3947405

  • EPIDEMIOLOGY OF CANCER IN RHEUMATOID-ARTHRITIS - METHODOLOGIC PITFALLS AMERICAN JOURNAL OF MEDICINE Fries, J. F. 1985; 78 (1A): 12-14

    Abstract

    Studies that try to associate immunoinflammatory disease, typified by rheumatoid arthritis, and malignancy have been limited by several important methodologic difficulties. Usually the hypothesis examined has been one of an increase in incidence of one or more specific neoplasms, and sometimes this hypothesis has been generated after examining the data. Some of the more common methods for assessing risk, including case reports and small series, case-control studies, hospital-based studies, and animal studies, and the competing risk fallacy can create problems of interpretation and can skew the results. The ideal study is one in which a random sample of 1,000 or more patients with rheumatoid arthritis are followed prospectively from disease onset to death and the data compared with total population data over the same period. Ideally, there would be perfect follow-up and autopsy information available on all patients and all control patients. Such studies of course will not be available. However, those studies that are designed best fail to associate rheumatoid arthritis with malignancy, although certain specific malignancies do appear associated with alkylating agent therapy for rheumatoid arthritis.

    View details for Web of Science ID A1985ABJ9500004

    View details for PubMedID 3970035

  • CANCER IN RHEUMATOID-ARTHRITIS - A PROSPECTIVE LONG-TERM STUDY OF MORTALITY AMERICAN JOURNAL OF MEDICINE Fries, J. F., Bloch, D., Spitz, P., MITCHELL, D. M. 1985; 78 (1A): 56-59

    Abstract

    Eight hundred and five consecutive patients with definite or classic rheumatoid arthritis, representative of a general population, were followed prospectively over an average of 12 years with 94 percent follow-up, during which time 233 patients died. Mortality rates were increased in rheumatoid arthritis by approximately 50 percent compared with population controls. "Excess deaths" (78) were due, in part, to disease-related causes, infections, and gastrointestinal problems secondary to therapy. Thirty-one deaths (14.1 percent) were due to malignancy, compared with 22.8 percent in non-age-adjusted population controls. Frequency of malignancy type (colon seven, lung four, breast three, prostate three, leukemia three, ovary three, stomach two, and lymphoma zero) did not differ significantly from the general population. Age-adjusted figures showed lower malignancy rates for patients with rheumatoid arthritis except after age 80. Two treatments were suitable for analysis. Gold-treated patients trended toward lower malignancy rates (11 versus 17 percent) than did those not treated with gold, and prednisone-treated patients had less malignancy (11 versus 20 percent) than did those not treated with prednisone. These data indicate that there is not an important increase in deaths due to malignancy in rheumatoid arthritis, and that at least two treatments, gold and prednisone, are not associated with higher risk of malignancy.

    View details for Web of Science ID A1985ABJ9500012

    View details for PubMedID 3970042

  • A CONTROLLED TRIAL OF ANTIHYPERTENSIVE THERAPY IN SYSTEMIC-SCLEROSIS (SCLERODERMA) ANNALS OF THE RHEUMATIC DISEASES Fries, J. F., Wasner, C., Brown, J., Feigenbaum, P. 1984; 43 (3): 407-410

    Abstract

    Antihypertensive treatment may be life saving in scleroderma renal crisis. Patients surviving such crises frequently have had dramatic improvement in the dermal manifestations of their scleroderma. To investigate the potential role of antihypertensive treatment in nonhypertensive patients we randomly assigned 28 patients with systemic sclerosis into drug (14) and placebo (14) groups, using blocked randomisation , and followed them up in a prospective, double-blind clinical trial for 24 months. Overall, both groups improved slightly, with both subjective and objective markers. There were no statistically significant differences and no clinically meaningful trends between the 2 groups, except that the blood pressure was reduced in the group on the active drug.

    View details for Web of Science ID A1984SW05500012

    View details for PubMedID 6378105

  • DISEASE CRITERIA FOR SYSTEMIC LUPUS-ERYTHEMATOSUS ARCHIVES OF INTERNAL MEDICINE Fries, J. F. 1984; 144 (2): 252-253

    View details for Web of Science ID A1984SC31600003

    View details for PubMedID 6696558

  • THE COMPRESSION OF MORBIDITY - MISCELLANEOUS COMMENTS ABOUT A THEME GERONTOLOGIST Fries, J. F. 1984; 24 (4): 354-359

    View details for Web of Science ID A1984TE42800004

    View details for PubMedID 6479648

  • THE CHRONIC DISEASE DATA-BANK - 1ST PRINCIPLES TO FUTURE-DIRECTIONS JOURNAL OF MEDICINE AND PHILOSOPHY Fries, J. F. 1984; 9 (2): 161-180

    Abstract

    Chronic diseases represent the major illness burden of developed nations. A chronic disease databank system consists of parallel longitudinal data sets from diverse locations describing the courses of thousands of patients with chronic illness over many years. Illustrated by ARAMIS (The American Rheumatism Association Medical Information System), such data resources facilitate analysis of long term health outcomes and the factors associated with particular outcomes. A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence of chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study. In this model, data are systematically accrued and continually analyzed, and the data collected are gradually modified based upon evolving anticipation of future needs. The strategies underlying the development of ARAMIS are described, investigational results summarized, and future directions outlined.

    View details for Web of Science ID A1984TA97700003

    View details for PubMedID 6332162

  • FROM EXPERIMENT TO EXPERIENCE - SIDE-EFFECTS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AMERICAN JOURNAL OF MEDICINE Coles, L. S., Fries, J. F., KRAINES, R. G., Roth, S. H. 1983; 74 (5): 820-828

    Abstract

    As part of the approval process, new drugs are first studied in controlled clinical trials with carefully selected patients. After gaining approval, however, these drugs are often used in the general community under widely different circumstances. This report explores the effects of such differences on the frequency and severity of side effects using the nonsteroidal anti-inflammatory drugs as a prototype. A review of clinical trials is compared with the accumulated experience at the Stanford and Phoenix Arthritis Centers. Statistical analysis of patient records was accomplished using the American Rheumatism Association Medical Information System Computer Data-Base System. To overcome potential biases in different methods of detecting side effects, a questionnaire was mailed directly to 390 patients, including subjects who were and were not participants in formal drug studies. Agreement between experiment and experience was generally quite good. However, a tendency for severe side effects to occur more frequently in community use than would be predicted from clinical trials was noted.

    View details for Web of Science ID A1983QP25600016

    View details for PubMedID 6340495

  • THE ASSESSMENT OF DISABILITY - FROM 1ST TO FUTURE PRINCIPLES BRITISH JOURNAL OF RHEUMATOLOGY Fries, J. F. 1983; 22 (3): 48-58

    Abstract

    Outcome assessment attempts to measure the long-term impacts of illness in order to select management strategies and public policies which minimize these impacts. Disability is an important dimension of outcome, particularly in conditions such as rheumatoid arthritis, but cannot be considered apart from other dimensions such as mortality, pain, iatrogenic problems, and economic impact since decisions frequently involve comparing positive effects in one dimension with negative effects in another. Modern techniques of survey research have yielded self-administered patient questionnaire instruments which are more reliable and more valid than traditional endpoints in rheumatic disease assessment and more relevant to the desires of the patient. These new techniques should be widely used in clinical investigation and in clinical practice.

    View details for Web of Science ID A1983RH31600009

    View details for PubMedID 6223681

  • THE COMPRESSION OF MORBIDITY MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY Fries, J. F. 1983; 61 (3): 397-419

    View details for Web of Science ID A1983RN45100003

    View details for PubMedID 6555590

  • TOWARD AN UNDERSTANDING OF PATIENT OUTCOME MEASUREMENT ARTHRITIS AND RHEUMATISM Fries, J. F. 1983; 26 (6): 697-704

    View details for Web of Science ID A1983QT94600001

    View details for PubMedID 6860372

  • AN ANALYSIS OF THE AMERICAN-RHEUMATISM-ASSOCIATION CRITERIA FOR RHEUMATOID-ARTHRITIS ARTHRITIS AND RHEUMATISM MITCHELL, D. M., Fries, J. F. 1982; 25 (5): 481-487

    Abstract

    When a community-derived population of 840 rheumatoid arthritis patients was used to test the American Rheumatism Association's 11 diagnostic criteria for rheumatoid arthritis, these criteria divided patients into 3 reasonably distinct classifications (probable, definite, and classic). The severity of disease increased in direct proportion to the number of positive criteria. Three criteria involve invasive procedures that are rarely performed; they are unnecessary for effective use of the other 8 criteria. Although 256 possible combinations of these 8 criteria exist, the criteria function principally to classify patients into only 7 major clinical syndromes, each of which corresponds to a major clinical presentation. By identifying the logical interrelationships between criteria in this report, we have confirmed their applicability and provided insight into the manner by which criteria classify patients.

    View details for Web of Science ID A1982NP65900001

    View details for PubMedID 7082397

  • SPECIAL ARTICLE - THE 1982 REVISED CRITERIA FOR THE CLASSIFICATION OF SYSTEMIC LUPUS-ERYTHEMATOSUS ARTHRITIS AND RHEUMATISM Tan, E. M., Cohen, A. S., Fries, J. F., Masi, A. T., MCSHANE, D. J., Rothfield, N. F., Schaller, J. G., Talal, N., Winchester, R. J. 1982; 25 (11): 1271-1277
  • A MULTI-CENTER STUDY OF OUTCOME IN SYSTEMIC LUPUS-ERYTHEMATOSUS .1. ENTRY VARIABLES AS PREDICTORS OF PROGNOSIS ARTHRITIS AND RHEUMATISM GINZLER, E. M., DIAMOND, H. S., Weiner, M., SCHLESINGER, M., Fries, J. F., Wasner, C., Medsger, T. A., Ziegler, G., Klippel, J. H., Hadler, N. M., Albert, D. A., Hess, E. V., SPENCERGREEN, G., GRAYZEL, A., Worth, D., Hahn, B. H., BARNETT, E. V. 1982; 25 (6): 601-611

    Abstract

    A retrospective study of factors influencing survival in 1,103 patients with systemic lupus erythematosus (SLE) was carried out at 9 university centers diverse in geographic, socioeconomic, and racial characteristics. The mortality and disease characteristics of the patients at study entry varied widely among centers. The survival rates from the time patients with a diagnosis of SLE were first evaluated at the participating center was 90% at 1 year, 77% at 5 years, and 71% at 10 years. Patients with a serum creatinine greater than 3 mg/dl at study entry had the lowest survival rates: 48%, 29%, and 12% at 1, 5, and 10 years, respectively. Survival rate also correlated independently with the entry hematocrit, degree of proteinuria, number of preliminary American Rheumatism Association criteria for SLE satisfied, and source of funding of medical care. When data were corrected for socioeconomic status, race/ethnic origin did not significantly influence survival. Survival rates varied widely at different participating institutions, generally due to differences in disease severity. Place of treatment was independently associated with survival only in the second year after study entry. Disease duration before study entry did not account for the differences in disease severity.

    View details for Web of Science ID A1982NT41900001

    View details for PubMedID 7092960

  • THE VARIABILITY OF IMMUNOLOGICAL LABORATORY TESTS JOURNAL OF RHEUMATOLOGY Feigenbaum, P. A., Medsger, T. A., KRAINES, R. G., Fries, J. F. 1982; 9 (3): 408-414

    Abstract

    To determine the clinical reliability of certain immunologic tests, serum complement (C3), DNA binding (DNAB), and fluorescent antinuclear antibody (FANA) were measured blindly at 2 university immunology laboratories on duplicate serum samples from 667 patients with connective tissue diseases. Twenty-seven percent of patients were differently classified as normal or abnormal for C3 by the 2 laboratories. The mean of paired differences was 25 mg% and large variability remained even after adjustment. Repeat assays on a random subset of 91 sera showed persistent variability. Fifteen percent of patients were differently classified by their DNAB results in 11% by FANA tests. Considering this variability, these "objective" laboratory tests alone are not sufficiently reliable for accurately defining diseases or disease activity.

    View details for Web of Science ID A1982NW48600013

    View details for PubMedID 6811741

  • THE DIMENSIONS OF HEALTH OUTCOMES - THE HEALTH ASSESSMENT QUESTIONNAIRE, DISABILITY AND PAIN SCALES JOURNAL OF RHEUMATOLOGY Fries, J. F., SPITZ, P. W., Young, D. Y. 1982; 9 (5): 789-793

    View details for Web of Science ID A1982PQ06200032

    View details for PubMedID 7175852

  • A MULTI-CENTER STUDY OF OUTCOME IN SYSTEMIC LUPUS-ERYTHEMATOSUS .2. CAUSES OF DEATH ARTHRITIS AND RHEUMATISM Rosner, S., GINZLER, E. M., DIAMOND, H. S., Weiner, M., SCHLESINGER, M., Fries, J. F., Wasner, C., Medsger, T. A., Ziegler, G., Klippel, J. H., Hadler, N. M., Albert, D. A., Hess, E. V., SPENCERGREEN, G., GRAYZEL, A., Worth, D., Hahn, B. H., BARNETT, E. V. 1982; 25 (6): 612-617

    Abstract

    Causes of death were examined for 1,103 systemic lupus erythematosus patients who were followed from 1965 to 1978 at 9 centers that participated in the Lupus Survival Study Group. A total of 222 patients (20%) died. Lupus-related organ system involvement (mainly active nephritis) and infection were the most frequent primary causes of death. Causes of death were similar throughout the followup period. Hemodialysis had little impact on the length of survival for patients with nephritis. Active central nervous system disease and myocardial infarction were infrequent causes of death. There were no deaths from malignancy.

    View details for Web of Science ID A1982NT41900002

    View details for PubMedID 7046757

  • NON-STEROIDAL ANTI-INFLAMMATORY AGENTS IN RHEUMATOID-ARTHRITIS AND ANKYLOSING-SPONDYLITIS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wasner, C., Britton, M. C., KRAINES, R. G., KAYE, R. L., Bobrove, A. M., Fries, J. F. 1981; 246 (19): 2168-2172

    Abstract

    The relative effectiveness of six nonsteroidal anti-inflammatory agents was studied in 33 patients with rheumatoid arthritis and 32 patients with ankylosing spondylitis in a double-blind, randomized, prospective study employing a six-way multiple crossover design with six-week trials of each agent. In ankylosing spondylitis, naproxen, indomethacin, and fenoprofen calcium were the most effective agents. In rheumatoid arthritis, relatively little mean difference between drugs was found. Most of this difference could be attributed to compliance factors, which favored drugs that required only a small number of pills daily. Despite the small differences in effect, patients had strong preferences. More than 85% of patients were still taking their preferred medication after a mean follow-up period of one year.

    View details for Web of Science ID A1981MP46600015

    View details for PubMedID 7026817

  • AGING, NATURAL DEATH, AND THE COMPRESSION OF MORBIDITY NEW ENGLAND JOURNAL OF MEDICINE Fries, J. F. 1980; 303 (3): 130-135

    Abstract

    The average length of life has risen from 47 to 73 years in this century, but the maximum life span has not increased. Therefore, survival curves have assumed an ever more rectangular form. Eighty per cent of the years of life lost to nontraumatic, premature death have been eliminated, and most premature deaths are now due to the chronic diseases of the later years. Present data allow calculation of the ideal average life span, approximately 85 years. Chronic illness may presumably be postponed by changes in life style, and it has been shown that the physiologic and psychologic markers of aging may be modified. Thus, the average age at first infirmity can be raised, thereby making the morbidity curve more rectangular. Extension of adult vigor far into a fixed life span compresses the period of senescence near the end of life. Health-research strategies to improve the quality of life require careful study of the variability of the phenomena of aging and how they may be modified.

    View details for Web of Science ID A1980JZ12000004

    View details for PubMedID 7383070

  • DETERMINING THE MOST VALUABLE CLINICAL-VARIABLES - STEPWISE MULTIPLE LOGISTIC-REGRESSION PROGRAM METHODS OF INFORMATION IN MEDICINE Coles, L. S., Brown, B. W., Engelhard, C., Halpern, J., Fries, J. F. 1980; 19 (1): 42-49

    View details for Web of Science ID A1980JE50100008

    View details for PubMedID 6986015

  • MEASUREMENT OF PATIENT OUTCOME IN ARTHRITIS ARTHRITIS AND RHEUMATISM Fries, J. F., Spitz, P., KRAINES, R. G., Holman, H. R. 1980; 23 (2): 137-145

    Abstract

    A structure for representation of patient outcome is presented, together with a method for outcome measurement and validation of the technique in rheumatoid arthritis. The paradigm represents outcome by five separate dimensions: death, discomfort, disability, drug (therapeutic) toxicity, and dollar cost. Each dimension represents an outcome directly related to patient welfare. Quantitation of these outcome dimensions may be performed at interview or by patient questionnaire. With standardized, validated questions, similar scores are achieved by both methods. The questionnaire technique is preferred since it is inexpensive and does not require interobserver validation. These techniques appear extremely useful for evaluation of long term outcome of patients with rheumatic diseases.

    View details for Web of Science ID A1980JF16100001

    View details for PubMedID 7362664

  • INFORMED CONSENT - RIGHT OR RITE CA-A CANCER JOURNAL FOR CLINICIANS Fries, J. F., Loftus, E. F. 1979; 29 (5): 316-318

    View details for Web of Science ID A1979HN63200008

    View details for PubMedID 113058

  • ENHANCEMENT OF CLINICAL PREDICTIVE ABILITY BY COMPUTER CONSULTATION METHODS OF INFORMATION IN MEDICINE Dannenberg, A. L., Shapiro, A. R., Fries, J. F. 1979; 18 (1): 10-14

    View details for Web of Science ID A1979GH13700003

    View details for PubMedID 763160

  • TIME-ORIENTED FUNCTIONAL PROFILE - PRACTICAL APPLICATIONS IN A STROKE DATA-BASE MODEL ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION FEIGENSON, J. S., Fries, J. F., Kunitz, S., McShane, D., GREENBERG, S. D. 1979; 60 (11): 512-516

    Abstract

    The feasibility of transferring data from a large computerized stroke data-base system (BUSTOP) to an existing time-oriented system of proven utility (ARAMIS) is demonstrated. Potential advantages of a time-oriented data-base system include: determination of prognostic indicators, suggestions for therapeutic intervention, analysis of experimental treatment programs, development of units of cost effectiveness and provision for uniform methods of auditing stroke care. This demonstration project shows that a large-scale stroke data-base system is feasible using existing computer models which are currently collecting and analyzing data-base statistics.

    View details for Web of Science ID A1979HT49500006

    View details for PubMedID 508078

  • TOD - SOFTWARE SYSTEM FOR THE ARAMIS DATA BANK COMPUTER MCSHANE, D. J., Harlow, A., KRAINES, R. G., Fries, J. F. 1979; 12 (11): 34-40
  • EDUCATION FOR OUTCOME JOURNAL OF RHEUMATOLOGY Fries, J. F. 1978; 5 (1): 1-2

    View details for Web of Science ID A1978EU75500001

    View details for PubMedID 641910

  • ASYMPTOMATIC HYPER-URICEMIA - CASE FOR CONSERVATIVE MANAGEMENT ANNALS OF INTERNAL MEDICINE Liang, M. H., Fries, J. F. 1978; 88 (5): 666-670

    Abstract

    The management of asymptomatic hyperuricemia is controversial. Reported benefits from treatment prevention of acute gouty arthritis, chronic tophaceous gout, urolithiasis, or gouty nephropathy. A review of experimental and clinical data suggests that the risks of asymptomatic hyperuricemia are small or unknown and the efficacy of long-term treatment in preventing gout or renal disease is unproved. The costs and risks of prolonged drug administration and practical considerations such as patient compliance mitigate against long-term therapy in asymptomatic persons. We offer some recommendations for an expectant approach to the management of asymptomatic hyperuricemia.

    View details for Web of Science ID A1978EX76300024

    View details for PubMedID 646260

  • PATIENT-ADMINISTERED QUESTIONNAIRE FOR ARTHRITIS ASSESSMENT CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Liang, M., Schurman, D. J., Fries, J. 1978: 123-129

    Abstract

    A patient-administered arthritis record system has been in use for 4 years. Thirty patients with various chronic arthritic conditions were studied to compare patient responses on the questionnaire to those obtained at the physician interview. Comparisons were also made between the "review of symptoms" and the actual physical findings documented in the medical record. The self-administered inventory of functional activities is a reliable and useful way to document specific activity achieved by a patient. Further, the questionnaires also aid in the evaluation of any therapeutic intervention and give a patient-perceived measurement of the clinical outcome in terms of quality of life. As a patient self-administered record, it allows for a major saving of physician time while acquiring accurate, complicated, but important, repetitive, time-oriented information. This system includes the American Rheumatism Association's Uniform Data Base for Rheumatic Diseases. An important set of questions has been added which improves functional assessment that is necessary to evaluate the success of surgical therapy.

    View details for Web of Science ID A1978EX11500016

    View details for PubMedID 657608

  • COMPARISON OF THERAPY IN SEVERE SYSTEMIC LUPUS-ERYTHEMATOSUS EMPLOYING STRATIFICATION TECHNIQUES JOURNAL OF RHEUMATOLOGY MCSHANE, D. J., Porta, J., Fries, J. F. 1978; 5 (1): 51-58

    Abstract

    Randomized studies, attempting to clarify the role of combined azathioprine and prednisone therapy versus prednisone alone in severe systemic lupus erythematosus have sustained rather than mollified a clinical controversy. No differences have been detected in some studies, while others have appeared to show benefit with addition of azathioprine. The present study suggests that neither small random trials nor uncorrected clinical experience can be expected to provide truly comparable control groups in conditions as variable as systemic lupus, but that stratification techniques can yield relatively similar groups. Patients meeting different entry characteristics are demonstrated to come to different outcomes. Depending upon the specifications of a subgroup, one therapy or another appears better.

    View details for Web of Science ID A1978EU75500008

    View details for PubMedID 641913

  • CONTAINING COSTS IN CHRONIC DISEASE - MONITORING STRATEGIES IN GOLD THERAPY OF RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Liang, M. H., Fries, J. F. 1978; 5 (3): 241-244

    View details for Web of Science ID A1978FX86400001

    View details for PubMedID 748547

  • SUCCESSFUL MEDICAL-TREATMENT OF SCLERODERMA RENAL CRISIS NEW ENGLAND JOURNAL OF MEDICINE Wasner, C., Cooke, C. R., Fries, J. F. 1978; 299 (16): 873-875

    View details for Web of Science ID A1978FT08300007

    View details for PubMedID 692581

  • MARGINAL BENEFIT OF RENAL BIOPSY IN SYSTEMIC LUPUS-ERYTHEMATOSUS ARCHIVES OF INTERNAL MEDICINE Fries, J. F., Porta, J., Liang, M. H. 1978; 138 (9): 1386-1389

    Abstract

    The predictive information provided by renal biopsy was assessed for four systemic lupus erythematosus (SLE) patient populations and compared with the predictive information from clinical data without benefit of biopsy, both measured against actual outcome. Renal biopsy results, whether studied by light or electron microscopy, contain important prognostic information. However, the prognostic information from renal biopsies in these patient groups is generally less than that of even the simplest clinical classifications; and when combined with clinical information, the total prognostic content is essentially that of the clinical information alone. Thus, judged by presently available data, the renal biopsy in SLE provides mainly redundant prognostic information. The marginal benefit is the difference between what is known before and after a test. Quantitation of predictive accuracy allows assessment of marginal benefit, that is, the increment in accuracy afforded by an additional test. Costly and potentially hazardous procedures, such as renal biopsy, require reassessment in terms of marginal rather than absolute predictive ability.

    View details for Web of Science ID A1978FP81600016

    View details for PubMedID 686930

  • CLINICAL ASPECTS OF SYSTEMIC LUPUS-ERYTHEMATOSUS MEDICAL CLINICS OF NORTH AMERICA Fries, J. F. 1977; 61 (2): 229-240

    View details for Web of Science ID A1977CZ50100004

    View details for PubMedID 853785

  • CLOSE CORRELATION BETWEEN SYMPTOMS AND DISEASE EXPRESSION IN HLA B27 POSITIVE INDIVIDUALS JOURNAL OF RHEUMATOLOGY Calin, A., Fries, J. F., Schurman, D., Payne, R. 1977; 4 (3): 277-281

    Abstract

    Following demonstration that 20 percent of presumed "healthy" HLA B27 positive individuals develop symptomatic ankylosing spondylitis, a controlled follow-up assessment of the remaining "asymptomatic" 80 percent was performed. The clinical and radiological study revealed that there is a close correlation between symptoms and radiologic change in HLA B27 positive subjects; those individuals remaining symptom free have normal pelvic radiographs. Ankylosing spondylitis or "asymptomatic sarcroiliitis" does not exist in a subclinical manner throughout the entire group of B27 positive subjects. Evaluation of the pelvic radiographs of both symptomatic and asymptomatic HLA B27 positive subjects and symptomatic HLA B27 negative controls demonstrated that osteitis pubis and fluffy periostitis are equally distributed among the three groups, only the frequency of sacroiliitis being statistically greater in the B27 positive symptomatic subjects.

    View details for Web of Science ID A1977DY58600008

    View details for PubMedID 144796

  • CLINICAL HISTORY AS A SCREENING-TEST FOR ANKYLOSING-SPONDYLITIS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Calin, A., Porta, J., Fries, J. F., Schurman, D. J. 1977; 237 (24): 2613-2614

    Abstract

    A controlled study of 138 subjects demonstrated that the clinical history may be sensitive (95%) and specific (85%) in the differential diagnosis of ankylosing spondylitis when reliance of five specific historic features is made. Back pain that is insidious in onset, in a patient younger than 40 years, persisting for at least three months, associated with morning stiffness and improving with exercise is characteristic of inflammatory spinal disease.

    View details for Web of Science ID A1977DH96700015

    View details for PubMedID 140252

  • SOME PROBLEMS IN INTERPRETATION OF CLINICAL-TRIALS - LONGTERM PARALLEL STUDY OF FENOPROFEN IN RHEUMATOID-ARTHRITIS JOURNAL OF RHEUMATOLOGY Fries, J. F., Britton, M. C. 1976; 3: 61-66
  • DATA BANK FOR CLINICIAN NEW ENGLAND JOURNAL OF MEDICINE Fries, J. F. 1976; 294 (25): 1400-1402
  • JOINT PAIN OR ARTHRITIS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Fries, J. F., MITCHELL, D. M. 1976; 235 (2): 199-204

    View details for Web of Science ID A1976BB28500028

    View details for PubMedID 946031

  • EXPERIMENTAL EPIDEMIC OF REITERS SYNDROME REVISITED - FOLLOW-UP EVIDENCE ON GENETIC AND ENVIRONMENTAL-FACTORS ANNALS OF INTERNAL MEDICINE Calin, A., Fries, J. F. 1976; 84 (5): 564-566

    Abstract

    The relation between a specific infective event (shigellosis), a specific disease entity (Reiter's syndrome), and a specific histocompatibility antigen (HL-A B27) is documented by follow-up study of an epidemic of post-Shigella Reiter's syndrome. Five of the original 10 patients have been traced, HL-A typed, and clinically assessed 13 years after the initial episode. One of the 5 has minimal disease, remains symptom-free, and is HL-A B27-negative. The remaining 4 have followed a chronic course, have persistent active disease, and are HL-A B27-positive. It is estimated that after this single episode of shigellosis, from one sixth to one third of the persons who were HL-A B27-positive developed Reiter's syndrome. The prognosis for postdysenteric Reiter's syndrome must be guarded, especially in the subject who is B27-positive.

    View details for Web of Science ID A1976BQ25500012

    View details for PubMedID 1275358

  • SIMULTANEOUS VASCULITIS IN A MOTHER AND NEWBORN-INFANT JOURNAL OF PEDIATRICS Miller, J. J., Fries, J. F. 1975; 87 (3): 443-445

    View details for Web of Science ID A1975AN62500024

    View details for PubMedID 1172532

  • STRIKING PREVALENCE OF ANKYLOSING-SPONDYLITIS IN HEALTHY W27 POSITIVE MALES AND FEMALES - CONTROLLED-STUDY NEW ENGLAND JOURNAL OF MEDICINE Calin, A., Fries, J. F. 1975; 293 (17): 835-839

    Abstract

    Ankylosing spondylitis is diagnosed once or twice in each 1000 males and one tenth as frequently in females, but the true prevalence is unknown. Indentification of genetic marker, HL-A W27, for susceptible persons has provided a tool facilitating epidemiologic studies and allowing identification of "control" populations without the marker. Evaluation by postal questionnaires, and pelvic radiography of 78 HL-A 27W-positive blood donors selected from a group of apparently healthy subjects revealed 14 who satisfied the criteria for definite ankylosing spondylitis. The prevalence was similar in both sexes. One hundred and twenty-six W27-negative controls matched for race, sex, and age failed to yield a single case. For a person of either sex with HL-A W27, there appears to be about a 20 per cent chance that ankylosing spondylitis will develop, suggesting a prevalence of 10 to 15 per thousand. Hitherto accepted figures may underestimate the frequency by a factor of 10 to 20.

    View details for Web of Science ID A1975AT46600001

    View details for PubMedID 126380

  • MODULAR SELF-DESCRIBING CLINICAL DATABANK SYSTEM COMPUTERS AND BIOMEDICAL RESEARCH WEYL, S., Fries, J., Wiederhold, G., Germano, F. 1975; 8 (3): 279-293

    View details for Web of Science ID A1975AG67600007

    View details for PubMedID 1157469

  • IRREVERSIBLE BONE-MARROW FAILURE WITH CHLORAMBUCIL JOURNAL OF RHEUMATOLOGY Rudd, P., Fries, J. F., EPSTEIN, W. V. 1975; 2 (4): 421-429

    Abstract

    Two cases of irreversible bone marrow failure are described, one with rheumatoid disease and one with systemic lupus erythematosus. Each case was associated with prior chlorambucil administration, effective in controlling the clinical manifestations (total dosage 398 and 1,764 mg respectively). The irreversibility of the bone marrow depression in the two cases presented stands in contrast to published assurances that chlorambucil-associated leukopenia is dose-related and readily reversible. The cases illustrate that chlorambucil therapy should not be continued after initial leukopenia, until peripheral counts or marrow cellularity has returned to normal. Titration of drug dosage and leukocyte count, as frequently employed with cyclophosphamide and other alkylating agents, must be presumed hazardous. Additional studies are needed to determine if irreversible bone marrow depression is dose-related or idiosyncratic.

    View details for Web of Science ID A1975BE40700010

    View details for PubMedID 1206673

  • LATE-STAGE LUPUS NEPHROPATHY JOURNAL OF RHEUMATOLOGY Fries, J. F., Powers, R., Kempson, R. L. 1974; 1 (2): 166-175

    View details for Web of Science ID A1974U033200007

    View details for PubMedID 4617003

  • INTRA-ARTERIALLY ADMINISTERED RESERPINE AND SALINE IN SCLERODERMA ARCHIVES OF INTERNAL MEDICINE Siegel, R. C., Fries, J. F. 1974; 134 (3): 515-518

    View details for Web of Science ID A1974U073400017

    View details for PubMedID 4604627

  • ALTERNATIVES IN MEDICAL RECORD FORMATS MEDICAL CARE Fries, J. F. 1974; 12 (10): 871-881

    View details for Web of Science ID A1974U402600006

    View details for PubMedID 4437218

  • INTRALUMINAL ESOPHAGEAL REWARMING IN NORMALS AND IN PATIENTS WITH CONNECTIVE-TISSUE DISEASE INVESTIGATIVE RADIOLOGY HARELL, G. S., Gold, J. A., Fries, J. F., Bradley, B., ZBORALSK, F. F. 1974; 9 (3): 186-192

    View details for Web of Science ID A1974T395800009

    View details for PubMedID 4836713

  • ESTIMATING PROGNOSIS IN SYSTEMIC LUPUS-ERYTHEMATOSUS AMERICAN JOURNAL OF MEDICINE Fries, J. F., WEYL, S., Holman, H. R. 1974; 57 (4): 561-565

    View details for Web of Science ID A1974U454700007

    View details for PubMedID 4432861

  • HEMODIALYSIS IN END-STAGE LUPUS NEPHRITIS TRANSACTIONS AMERICAN SOCIETY FOR ARTIFICIAL INTERNAL ORGANS Coplon, N., Siegel, R., Fries, J. 1973; 19: 302-304

    View details for Web of Science ID A1973Q327700047

    View details for PubMedID 4579028

  • TESTING PRELIMINARY CRITERIA FOR CLASSIFICATION OF SLE ANNALS OF THE RHEUMATIC DISEASES Fries, J. F., Siegel, R. C. 1973; 32 (2): 171-177

    View details for Web of Science ID A1973P113100014

    View details for PubMedID 4571393

  • FENOPROFEN CALCIUM IN RHEUMATOID-ARTHRITIS - CONTROLLED DOUBLE-BLIND CROSSOVER EVALUATION ARTHRITIS AND RHEUMATISM Fries, J. F., Britton, M. C. 1973; 16 (5): 629-634

    View details for Web of Science ID A1973R022600006

    View details for PubMedID 4270280

  • ADRENOCORTICAL STEROID TREATMENT OF RHEUMATIC DISEASES - EFFECTS ON LIPID-METABOLISM ARCHIVES OF INTERNAL MEDICINE Stern, M. P., KOLTERMA, O. G., Fries, J. F., McDevitt, H. O., Reaven, G. M. 1973; 132 (1): 97-101

    View details for Web of Science ID A1973Q200900011

    View details for PubMedID 4541465

  • SCLERODERMA-LIKE LESIONS AND CARCINOID-SYNDROME ARCHIVES OF INTERNAL MEDICINE Fries, J. F., Lindgren, J. A., BULL, J. M. 1973; 131 (4): 550-553

    View details for Web of Science ID A1973P379200009

    View details for PubMedID 4699960

  • CYCLOPHOSPHAMIDE THERAPY IN SYSTEMIC LUPUS-ERYTHEMATOSUS AND POLYMYOSITIS ARTHRITIS AND RHEUMATISM Fries, J. F., Sharp, G. C., McDevitt, H. O., Holman, H. R. 1973; 16 (2): 154-162

    View details for Web of Science ID A1973P351100003

    View details for PubMedID 4716431

Conference Proceedings


  • Cross-Sectional Validation of the Patient Reported Outcome Measurement Information System Pediatric Scales in Juvenile Idiopathic Arthritis, Childhood Systemic Lupus Erythematosus, and Juvenile Dermatomyositis DeWitt, E. M., Gross, H., Stucky, B. D., Liu, Y., Thissen, D., Lovell, D. J., Wallace, C. A., Fries, J. F., Bruce, B., Rabinovich, E. C., Schanberg, L. E., DeWalt, D. WILEY-BLACKWELL. 2011: S735-S735
  • Standardizing assessment and reporting of adverse effects in rheumatology clinical trials II: the rheumatology common toxicity criteria v.2.0 Woodworth, T., Furst, D. E., Alten, R., Bingham, C., Yocum, D., Sloan, V., Tsuji, W., Stevens, R., Fries, J., Witter, J., Johnson, K., Lassere, M., Brooks, P. J RHEUMATOL PUBL CO. 2007: 1401-1414

    Abstract

    The OMERACT Drug Safety Working Group focuses on standardization of assessment and reporting of adverse events in clinical trials and longitudinal and observational studies in rheumatology. This group developed the Rheumatology Common Toxicity Criteria (RCTC) in 1999, building on the Oncology Common Toxicity Criteria. At OMERACT 8, a workshop group reviewed the use of the RCTC and other instruments in rheumatology clinical trials to date, to revise and to stimulate its implementation.The Working Group drafted a revision of the RCTC after an iterative examination of its contents, terms, and definitions. The RCTC were compared with the Oncology Common Toxicity Criteria (CTC v.2.0), and the Common Terminology Criteria for Adverse Events (CTCAE v.3.0). In addition a pharmaceutical company focus group met to clarify the challenges of application of RCTC terms and definitions, relative to the standard in pharmaceutical clinical trials, i.e., verbatim recording of adverse events followed by mapping to Medical Dictionary of Drug Regulatory Activities (MedDRA) terms. The workshop focused on the proposed revision of RCTC to version 2.0 and on the research agenda, including a validation of the RCTC in future trials.At OMERACT 8, breakout groups amended the contents of the 4 current and 2 new categories of adverse event terms within the draft RCTC v.2.0. Participants recognized the need to standardize the definitions for disease flares, infection, malignancy, and certain syndromes such as drug hypersensitivity and infusion reactions. Moderate consensus (62%) was reached in the final plenary session that the amended RCTC v.2.0 should be promulgated and tested in available trials of anti-tumor necrosis factor agents.The RCTC has face validity and construct validity. However, documentation of discrimination and feasibility (the other elements of the OMERACT filter) is needed. Collaboration with drug safety working groups in rheumatology professional organizations is necessary to enable this project.

    View details for Web of Science ID 000247116600032

    View details for PubMedID 17552067

  • Arthritis therapies and risk of myocardial infarction. Hubert, H. B., Luggen, M., Sibley, J., Fries, J. F., Ward, M., Lingala, B., Wasko, M. C. WILEY-BLACKWELL. 2006: S784-S785
  • Hydroxychloroquine reduces diabetes risk in RA. Wasko, M. C., Luggen, M., Sibley, J., Lingala, B., Ward, M., Fries, J. F., Hubert, H. B. WILEY-BLACKWELL. 2006: S785-S786
  • Standardized assessment of adverse events in rheumatology clinical trials: Summary of the OMERACT 7 Drug Safety Module update Lassere, M. N., Johnson, K. R., Boers, M., Carlton, K., Day, R. O., de Wit, M., Edwards, I. R., Fries, J. F., Furst, D. E., Kirwan, J. R., Tugwell, P. S., Woodworth, T. G., Brooks, P. M. J RHEUMATOL PUBL CO. 2005: 2037-2041

    Abstract

    A presentation, demonstration, and discussion of recently developed adverse event instruments were the topics for the OMERACT 7 Drug Safety Module. The module began with a plenary introducing the needs and challenges of adverse event ascertainment. It was followed by a review of module work from previous OMERACT meetings on a prototype coding instrument (Rheumatology Common Toxicity Criteria), then a brief description of the process behind the recently developed patient self-report and investigator report adverse event instruments. These current instruments are designed for use in controlled trials although they could be used in other settings. The instruments rely primarily on patient self-reporting using a checklist, which the investigator then folds into a parallel structured but more medically sophisticated instrument. In pilot testing, this innovative dual-use system has shown reliability and acceptability, while preserving validity. A "stakeholder panel" of representatives from 8 sectors followed--patient, nurse investigator, regulator, clinician scientist, industry, OMERACT, global public health/WHO, and Cochrane Collaboration--for their perspectives on the needs, challenges, and potential ways forward for adverse event ascertainment and reporting in clinical trials. At the breakout session small focus groups participated in hands-on interactive testing of one of 3 versions of the instruments, which differ in degree of comprehensiveness. Each focus group had a participatory patient with rheumatoid arthritis. At a second plenary there was group feedback by rapporteurs and presentation of results from pilot studies of iterative testing of validity, reliability, and feasibility of the instruments. During plenary discussion a frequent suggestion for improvement was to refine the process so that event ascertainment could be done entirely using the patient instrument with minimal input from the investigator at the visit, if patient-investigator agreement was high. Most found the patient checklist attractive, particularly if the patient instrument was shown to be reliable and valid. Finally, a future research agenda was discussed.

    View details for Web of Science ID 000232383800034

    View details for PubMedID 16206366

  • Challenges and progress in adverse event ascertainment and reporting in clinical trials Lassere, M. N., Johnson, K. R., Woodworth, T. G., Furst, D. E., Fries, J. F., Kirwan, J. R., Tugwell, P. S., Day, R. O., Brooks, P. M. J RHEUMATOL PUBL CO. 2005: 2030-2032

    Abstract

    Toxicity, safety, and tolerability are integral facets of patient risk/benefit decisions, yet the capacity to define, measure, and compare these aspects is underdeveloped compared to aspects of efficacy. There are many reasons for this, scientific and administrative, but all are surmountable. Probably the greatest primary obstacle is the absence of a measurement instrument designed specifically for this purpose. There are increasing calls from various stakeholders for better evidence, and therefore better ascertainment, in this area, especially in randomized trials, and for these reasons OMERACT began deliberations about these concepts in 1994. A prototype coding instrument (the Rheumatology Common Toxicity Criteria) was developed and discussed at OMERACT 5. In the 2 years before OMERACT 7, a process of concept development and iterative design and testing were conducted to develop a patient self-report and investigator-reported adverse event instruments designed for use in trials at the time of visit. The predominant workload is performed by the patient in a self-report checklist, which is then mapped by the trialist onto a medically sophisticated version. This article presents background on the process of developing a dual adverse event instrument, which was presented and critically discussed in detail at OMERACT 7.

    View details for Web of Science ID 000232383800032

    View details for PubMedID 16206364

  • HLA-DRB1, increased disease severity, and improved treatment response over two years in a rheumatoid arthritis (RA) inception cohort. Zatarain, E., Fries, J. F., Bennett, M., Hubert, H., Apple, R., Erlich, H., Bruce, B. WILEY-BLACKWELL. 2004: S400-S400
  • Progression of knee osteoarthritis in senior runners and controls: An 18-year longitudinal study Zatarain, E., Fries, J. F., Bennett, M., Lingala, B. WILEY-BLACKWELL. 2004: S144-S145
  • Arthritis antigen microarray analysis reveals associations of distinct autoantibody profiles with markers of disease activity and severity in RA. Hueber, W., Kidd, B., Lee, B. J., Genovese, M., Bruce, B., Fries, J., van Venrooij, W., Robinson, W. H. WILEY-BLACKWELL. 2004: S651-S651
  • Vigorous exercise and reduced medical care costs: The disability link Fries, J. F., Bennett, M., Lingala, B., Hubert, H. WILEY-BLACKWELL. 2004: S506-S506
  • The rise and fall of NSAID gastropathy Fries, J. F., Murtagh, K. N., Bennett, M., Zatarain, E., Lingala, B., Bruce, B. WILEY-BLACKWELL. 2003: S439-S439
  • The declining incidence of nonsteroidal anti-inflammatory drug gastropathy in rheumatoid arthritis patients: rates and reasons Fries, J., Murtaugh, K., Bennett, M., Zatarain, E., Lingala, B., Bruce, B. BIOMED CENTRAL LTD. 2003: S38-S38

    View details for DOI 10.1186/ar922

    View details for Web of Science ID 000220116700123

  • Projections of long-term functional disability in patients with early rheumatoid arthritis (RA) diagnosed in the bear 2002: Desiderata for novel therapies. Krishnan, E., Sokka, T., Wang, B. W., Singh, G., Fries, J. F. WILEY-BLACKWELL. 2002: S530-S530
  • Rates of serious gastrointestinal (GI) adverse events from low dose acetylsalicylic acid (ASA), acetaminophen (APAP), and ibuprofen (IBU) in osteoarthritis (OA) and rheumatoid arthritis (RA) patients. Fries, J. F., Holmes, T. H., Bruce, B. WILEY-BLACKWELL. 2002: S463-S463
  • Current treatment paradigms in rheumatoid arthritis Fries, J. F. OXFORD UNIV PRESS. 2000: 30-35

    Abstract

    Rheumatoid arthritis (RA) has traditionally been treated using the pyramid approach, in which non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment and disease-modifying anti-rheumatic drugs (DMARDs) are introduced relatively late in the disease. This approach is no longer valid. Previously regarded as a benign disease, RA is now recognized as causing substantial morbidity and mortality, as do the NSAIDs used in treatment. DMARDs are more effective in controlling the pain and disability of RA than NSAIDs, and are often no more toxic. The current treatment paradigm emphasizes early, consistent use of DMARDs. A 'sawtooth' strategy of DMARD use has been proposed, in which a rising but low level of disability triggers a change in therapy. Determining the most clinically useful DMARD combinations and the optimal sequence of DMARD use requires effectiveness studies, Bayesian approaches and analyses of long-term outcomes. Such approaches will allow optimization of multiple drug therapies in RA, and should substantially improve the long-term outcome for many patients.

    View details for Web of Science ID 000087832200006

    View details for PubMedID 11001377

  • Compression of morbidity in the elderly Fries, J. F. ELSEVIER SCI LTD. 2000: 1584-1589

    Abstract

    The Compression of morbidity paradigm envisions reduction in cumulative lifetime morbidity through primary prevention by postponing the age of onset of morbidity to a greater amount than life expectancy is increased, largely by reducing the lifestyle health risks which cause morbidity and disability. Recent data document slowly improving age-specific health status for seniors, indicate that postponement of the onset of disability by at least 10 years is feasible, and prove effectiveness of some lifestyle interventions by randomized controlled trials. Human aging is increasingly represented by frailty, with declining reserve function of many organ systems, including the immune system. Enhancement of immune function in this setting raises medical, ethical, and social issues which are sometimes in conflict.

    View details for Web of Science ID 000085866000003

    View details for PubMedID 10689132

  • How may quality of life for rheumatoid arthritis patients be enhanced by current and future treatments? Fries, J. F. OXFORD UNIV PRESS. 1999: 35-40

    Abstract

    Health-related quality of life is best thought of simply as 'health'. Life quality in patients with rheumatoid arthritis (RA) is affected, for good or ill, by treatment effects. Health status now is readily and validly measurable, using the Health Assessment Questionnaire or other instruments. Disability and pain are reduced by disease-modifying anti-rheumatic drugs (DMARDs) much more than by non-steroidal anti-inflammatory drugs (NSAIDs). Toxicity considerations vary among individual drugs but are roughly comparable between NSAIDs and DMARDs, mandating DMARD-based treatment strategies. Future therapies must accentuate the positives (reduction in pain and disability) while reducing the negatives (unwanted effects) if the health of RA patients is to be improved.

    View details for Web of Science ID 000083832900010

    View details for PubMedID 10646489

  • Comparative GI toxicity of NSAIDs. Singh, G., Terry, R., Ramey, D. R., Fries, J. F., Triadafilopoulos, G., Halpern, J., Brown, B. W. WILEY-BLACKWELL. 1997: 507-507
  • Running and osteoarthritis of the knee: A 12 year longitudinal study. Lane, N. E., Oehlert, J., Ward, M., Genovese, M., Bloch, D., Fries, J. F. WILEY-BLACKWELL. 1997: 1242-1242
  • Assessment of quality of life in early stage HIV-infected persons: data from the AIDS Time-Oriented Health Outcome Study (ATHOS) Lubeck, D. P., Fries, J. F. SPRINGER. 1997: 494-506

    Abstract

    The development of new pharmaceutical interventions for persons with human immunodeficiency virus (HIV) infection has resulted in extended survival and a need for valid, reliable and responsive instruments to assess health-related QoL (HRQoL). This paper reviews the reliability and validity of an HRQoL instrument, the AIDS Health Assessment Questionnaire (AIDS-HAQ), among persons participating in an observational database of HIV infection. The AIDS-HAQ includes nine subscales: disability, energy, general health, pain, cognitive functioning, mental health, social functioning, health distress and symptoms. Individuals complete the AIDS-HAQ quarterly. Data are reported for 440 individuals entering the study with early HIV infection. Fifty-nine progressed to symptomatic disease and 109 to AIDS after 1 year. The subscales of the instrument resulted in high internal consistency reliability (range = 0.79-0.88). Concurrent validity data reflected the ability to distinguish between patients with increasing disease severity. In all domains, except cognitive functioning, individuals who progressed to AIDS had significant decrements (p < 0.01) in HRQoL compared with symptomatic and asymptomatic patients. Significant decrements (p < 0.01) were observed for disability, general health, energy and symptoms for patients who progressed to symptomatic disease from an asymptomatic status. Individuals who had decreasing CD4+ counts also had significant declines (p < 0.001) in disability, general health, social functioning, pain and symptoms. The AIDS-HAQ is an instrument that can be used when comparing group differences and within group changes in observational databases, naturalistic studies and clinical trials.

    View details for Web of Science ID A1997XX98000005

    View details for PubMedID 9330550

  • Long-term medical costs and outcomes are significantly associated with early changes in disability in rheumatoid arthritis. Singh, G., Terry, R., Ramey, D., Wolfe, F., Fries, J. WILEY-LISS. 1996: 1738-1738
  • Costs of medical care for patients with osteoarthritis and rheumatoid arthritis: A 13 year study Singh, G., Ramey, D., Terry, R., Wolfe, F., Fries, J. WILEY-LISS. 1996: 269-269
  • Prevention of osteoporotic fractures: Possibilities, the role of exercise, and limitations Fries, J. F. INFORMA HEALTHCARE. 1996: 6-10

    Abstract

    The Compression of Morbidity paradigm seeks to reduce lifetime illness and morbidity by compressing the dominant morbidity, that of the senior years, between an increasing age of onset of morbidity and a more slowly increasing average age at death. Fractures, often associated with osteoporosis, cause a substantial part of this morbidity. For morbidity resulting from fractures to be reduced, the age-specific incidence of fractures needs to decline, since treatment of fractures after they occur is not likely to prove a major benefit. Thus, the risk factors need to be identified and appropriate preventive interventions undertaken. The medical model seeks to diagnose, then to treat those with disease. In considering prevention, many apply the medical model. The disease is "osteoporosis", we must identify people with this disease and then treat them. The public health model, in contrast, seeks to prevent "disease" in all susceptibles. The disease is "morbidity resulting from fractures". The fatal flaws in the medical screening approach will be discussed, together with a lament that this conference was not entitled: "Recent Progress in the Prevention of Morbidity Associated with Fractures". Osteoporosis is only one of many factors associated with increased morbidity resulting from fractures. A fracture management model for reduction in this morbidity will be presented. Osteoporosis finds its genesis in many well-identified risk factors, including age, sex, estrogen levels, and exercise levels, together with positive (e.g. calcium, estrogen) and negative (corticosteroids) effects of medications. Falls, the other main branch of the model, find their genesis is such risk factor as slippery floors, medication side effects, and co-morbid conditions, often with their own antecedent risk factors. Together, over twenty preventable risk factors contribute to the major morbidity associated with fractures.

    View details for Web of Science ID A1996UQ08800003

    View details for PubMedID 8966492

  • MEDICAL COSTS ARE STRONGLY ASSOCIATED WITH DISABILITY LEVELS IN RHEUMATOID-ARTHRITIS (RA) Fries, J. F., WILLIAMS, C. A., Ramey, D. R., Singh, G. WILEY-BLACKWELL. 1995: 208-208
  • EPIDEMIOLOGY OF NSAID-INDUCED GASTROINTESTINAL SIDE-EFFECTS Singh, G., Ramey, D., MORFELD, D., Shi, H., Fries, J. WILEY-BLACKWELL. 1995: 646-646
  • THE CLINICAL AND ECONOMIC CONSEQUENCES OF NDAID THERAPY Singh, G., Ramey, D., MORFELD, D., Shi, H., Fries, J. WILEY-BLACKWELL. 1995: 324-324
  • RESPONSE TO THERAPY IN RHEUMATOID-ARTHRITIS (RA) IS DEPENDENT UPON IMMEDIATELY PRIOR THERAPY Fries, J. F., WILLIAMS, C. A., Singh, G., Ramey, D. R. WILEY-BLACKWELL. 1995: 1296-1296
  • LYMPHOMA AND LEUKEMIA IN RHEUMATOID-ARTHRITIS - A MATCHED CASE-CONTROL STUDY IN THE ARAMIS (ARTHRITIS, RHEUMATISM AND AGING MEDICAL INFORMATION-SYSTEM) POPULATION WILLIAMS, C. A., Bloch, D. A., Sibley, J., Haga, M., Wolfe, F., Raynauld, J. P., Singh, G., Hickey, A. R., Fries, J. F. WILEY-BLACKWELL. 1995: 311-311
  • THE COSTS OF IMMUNOSUPPRESSIVE THERAPY FOR RHEUMATOID-ARTHRITIS Singh, G., Ramey, D. R., Fries, J. F. WILEY-BLACKWELL. 1993: S178-S178
  • RUNNING ACTIVITY AND THE DEVELOPMENT OF DISABILITY WITH AGE - 8-YEAR LONGITUDINAL-STUDY Fries, J. F., MORFELD, D., Hubert, H. B., Lane, N. E., Singh, G. WILEY-BLACKWELL. 1993: S234-S234
  • RISK-FACTORS FOR NSAID-ASSOCIATED GASTROPATHY IN RHEUMATOID-ARTHRITIS AND OSTEOARTHRITIS Ramey, D. R., Singh, G., Fries, J. F. WILEY-BLACKWELL. 1993: S194-S194
  • THE COMPARATIVE TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) IN RHEUMATOID-ARTHRITIS (RA) - 1992 Fries, J. F., Singh, G., Ramey, D. R., MORFELD, D., WILLIAMS, C. A., Bloch, D. A. WILEY-LISS. 1992: S236-S236
  • A STUDY TO ASSESS RADIOGRAPHIC LUMBAR-DISK DEGENERATION Lane, N. E., Michel, B. A., BJORKENGREN, A., Shi, H., Bloch, D. A., Fries, J. F. WILEY-LISS. 1992: S295-S295
  • GASTROINTESTINAL HOSPITALIZATIONS IN RHEUMATOID-ARTHRITIS PATIENTS TREATED WITH MISOPROSTIL - A PRELIMINARY-ANALYSIS Ramey, D. R., Singh, G., Fries, J. F. WILEY-LISS. 1992: S343-S343
  • A REASSESSMENT OF ASPIRIN THERAPY IN RHEUMATOID-ARTHRITIS (RA) Fries, J. F., Singh, G., Raynauld, J. P., Ramey, D. R., MORFELD, D., WILLIAMS, C. A. WILEY-LISS. 1992: S234-S234
  • A FRENCH-CANADIAN VERSION OF THE HEALTH ASSESSMENT QUESTIONNAIRE Raynauld, J. P., Singh, G., SHIROKY, J. B., Haraoui, B., Choquette, D., BLIER, C., Fortin, P., Pelletier, J. P., Gascon, J., Goulet, J. R., Neville, C., Fries, J. F. WILEY-LISS. 1992: S125-S125
  • ASSESSING AND UNDERSTANDING PATIENT RISK Fries, J. F. SCANDINAVIAN UNIVERSITY PRESS. 1992: 21-24

    Abstract

    Nonsteroidal anti-inflammatory drug (NSAID) gastropathy is the most frequent and one of the most severe drug side effects in the United States. NSAID-associated gastropathy has been estimated to account for at least 7600 deaths and 76000 hospitalizations each year in the United States alone. Hospitalizations in rheumatoid arthritis patients occurred in 1.6% of patients; for patients with osteoarthritis the incidence appears to be substantially lower. This is based on a consecutive series of 3000 patients with rheumatoid arthritis who were followed prospectively for an average of five years by ARAMIS, the Arthritis, Rheumatism and Aging Medical Information System. Multivariate analyses assessing risk factors for serious gastrointestinal (GI) events were performed on 1694 rheumatoid arthritis patients taking NSAIDs. The most important risk factors of higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, functional disability (based on the American Rheumatism Association classification), and NSAID dose are variables in an algorithm which estimates the risk of a serious GI event occurring in the next 12 months. Knowledge of risk factors and their interrelationships provides a tool for identifying patients at high risk and guides therapeutic decisions.

    View details for Web of Science ID A1992HQ73900005

    View details for PubMedID 1574684

  • THE EPIDEMIOLOGY OF SYSTEMIC LUPUS-ERYTHEMATOSUS - 1950-1990 CONCEPTUAL ADVANCES AND THE ARAMIS DATA BANKS Fries, J. F. ROYAL BELG RHEUMATOL SOC. 1990: 5-9

    View details for Web of Science ID A1990DQ39100002

    View details for PubMedID 2394083

  • TREATMENT OF RHEUMATOID-ARTHRITIS WITH REGIONAL LYMPHOID IRRADIATION Kotzin, B. L., Strober, S., Slavin, S., Gottlieb, M., Calin, A., Fries, J., Hoppe, R., KAPLAN, H. S. LIPPINCOTT-RAVEN PUBL. 1979: 632-632
  • METABOLISM OF I-125-C3 IN SYSTEMIC LUPUS-ERYTHEMATOSUS (SLE) Petz, L., Powers, R., Fries, J., Cooper, N., Holman, H. SLACK INC. 1976: A111-A111
  • HEMODIALYSIS AND TRANSPLANTATION IN LUPUS NEPHRITIS Fries, J. F., Siegel, R. C., Coplon, N. S. WILEY-BLACKWELL. 1973: 117-118

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