Showing papers by "James F. Fries published in 2012"
TL;DR: Seniors with fewer behavioral risk factors during middle age have lower disability and improved survival, and these data document that the associations of lifestyle risk factors on health continue into the ninth decade.
100 citations
TL;DR: Aggressive use of traditional disease-modifying agents and introduction of biological agents were associated with substantial gains in disability outcomes, which supports the prevailing notion that ‘tight inflammation control’ is a desirable therapeutic strategy.
Abstract: Objective 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. Methods 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. Results 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. Conclusion Aggressive use of traditional diseasemodifying agents and introduction of biological agents were associated with substantial gains in disability outcomes. Our fi nding supports the prevailing notion that ‘tight infl ammation control’ is a desirable therapeutic strategy.
62 citations
TL;DR: Differences increase over time, occur in all subgroups, and persist after statistical adjustment, which contrasts with the old, where increasing longevity inevitably leads to increasing morbidity.
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.
45 citations
TL;DR: 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, but improvements in functional disability were similar.
Abstract: Introduction: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.Objective: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.Methods: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 Questi...
27 citations
TL;DR: Although generally safe, all non-prescription analgesics are associated with some harm, particularly when recommended dosing limits are exceeded, and research to quantify the competing risks of different analgesic strategies is urgently needed.
Abstract: Objective: 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.Methods: 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.Results: 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 competi...
20 citations
01 Jan 2012
TL;DR: The Health Assessment Questionnaire was one of the first self-report functional status (disability) measures and has become the dominant instrument in many disease areas, including arthritis.
Abstract: The Health Assessment Questionnaire (HAQ) was originally developed in 1978 by James F. Fries, MD, and colleagues at Stanford University. It was one of the first self-report functional status (disability) measures and has become the dominant instrument in many disease areas, including arthritis. It is widely used throughout the world and has become a mandated outcome measure for clinical trials in rheumatoid arthritis and some other diseases.
11 citations
TL;DR: E Epidemiologic studies of OA identify age, female gender, and obesity as major risk factors for knee OA, but they do not include exercise (absent trauma) as a risk factor1,13,14.
Abstract: Regular, vigorous physical exercise confers numerous benefits. These include markedly postponing disability, prolonging life, strengthening bones, improving cardiac function and quality of life, reducing frailty, and retarding progression of aging markers in many organ systems1,2,3,4. Effects of exercise upon radiographic osteoarthritis (OA), particularly of the knee, have also been examined, partly because the original “wear and tear” hypothesis of OA development suggested that excessive weight-bearing exercise might cause accelerated joint damage and might result in more knee replacement surgery.
The “wear” component of this hypothesis has been generally disproven, although elements of the “tear” component remain in the context of contact sports5. Pain-free exercise does not appear to accelerate OA development, and has been postulated to have a protective effect. For example, after accounting for body mass index (BMI), the Framingham Study6,7,8 reported no association between exercise and knee OA. Rogers, et al 2 showed a protective effect of exercise for knee OA. Manninen, et al 9 found a dose-response protective exercise effect for knee arthroplasty, and Racunica, et al 10 showed an exercise benefit to knee articular structures during development. Similarly, Jones, et al 11 found healthier cartilage in exercising children. Recently, we observed a trend toward fewer knee arthroplasties in vigorous lifetime exercisers, principally long-distance runners over hard surfaces12. Epidemiologic studies of OA identify age, female gender, and obesity as major risk factors for knee OA, but they do not include exercise (absent trauma) as a risk factor1,13,14. Indeed, numerous reports describe exercise as currently perhaps the single most important treatment for OA.
Responding to issues related to …
Address correspondence to Dr. Bruce; E-mail: bbruce{at}stanford.edu
2 citations