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Showing papers by "James F. Fries published in 1988"


Journal ArticleDOI
TL;DR: The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA).
Abstract: The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.

19,409 citations


Journal Article
TL;DR: 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 and the data suggest that such information can be easily and inexpensively obtained.
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.

291 citations


Journal ArticleDOI
TL;DR: The compression of morbidity thesis notes that the species' life span is finite and that the onset of chronic disease is relatively easily delayed, so the period from onset of Chronic infirmity to death may be shortened, with both individual and social benefit.
Abstract: The national illness burden has shifted over recent decades from acute to chronic illness and from younger to older individuals [1,2]. The problems of chronic illness mix with and finally give way to senescent problems. Our future population will contain substantially more older individuals, as the birth cohorts of the 1920s and 1930s now approaching their seniority are larger than previous cohorts, and average life expectancy also is increasing. These commonly made observations lead some to postulate a dark future of increasing dependency, worsening health, and spiraling health care costs. The ability of society to pay everincreasing costs for ever more vegetative existence has been called into severe question. However, these somber predictions are not rooted in current knowledge of chronic disease and senescence, and they are not necessarily accurate. There is a much more hopeful paradigm, that of the \"compression of morbidity\" [1—10]. Rather than assuming that disease is fixed and the life span indefinitely extensible, the compression of morbidity thesis notes that the species' life span is finite and that the onset of chronic disease is relatively easily delayed. Thus, the period (in each individual life) from onset of chronic infirmity to death may be shortened, with both individual and social benefit.

91 citations



Journal ArticleDOI
TL;DR: This study analyzes strategies for inference of missing data in a time-oriented data bank of patients with systemic lupus erythematosus, demonstrating that interpolation is the best single technique with these data while linear regression of correlated co-recorded variables is a relatively weak technique.

14 citations


Journal Article
TL;DR: A system of postmarketing surveillance of antirheumatic drugs employing prospective protocol based consecutive patient cohorts using recursive partitioning techniques for statistical adjustment for potentially confounding variables and an analysis of 2 side effects (purpura and upper abdominal pain) is presented.
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.

11 citations



Journal ArticleDOI
01 Jun 1988
TL;DR: An overview of the American Rheumatism Association Medical Information System (ARAMIS), a national database and database management system containing parallel longitudinal clinical data sets from 17 rheumatic disease centers, is provided.
Abstract: The authors provide an overview of the American Rheumatism Association Medical Information System (ARAMIS), a national database and database management system containing parallel longitudinal clinical data sets from 17 rheumatic disease centers. 22 000 patients and 183000 observation time points are represented. The database contains measures of five dimensions-death, disability, discomfort, iatrogenic, and economic-and subdivisions of each dimension that provide a measure of the impact of the disease. The database management system is the MEDLOG time oriented database statistical software system. It runs on MOS-DOS-compatible microcomputers MEDLOG's file limits and abilities are described, and future directions for ARAMIS and MEDLOG are briefly covered. >

4 citations