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.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780310302

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody 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 in the 1982 revised criteria 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.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780251101

The 1982 revised criteria for the classification of systemic lupus erythematosus

K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification

In 1982, the Diagnostic and Therapeutic Criteria Committee of the American College of Rheumatology (ACR)published revised criteria for the classification of systemiclupus erythematosus (SLE) (1). During the ensuing decade several investigators, including Drs. Graham Hughes and Donato Alarcon-Segovia, among others, have described the presence and clinical associations or antiphospholipid antibodies in patients with SLE, as well as the occurrence of theprimary antiphospholipid syndrome (2-5). In 1992, Piette and colleagues suggested that the ACR revised criteria be reevaluated in light of the above discoveries (6).

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780400928

Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780330203

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.

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.

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

Successful aging—an emerging paradigm of gerontology

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) than community controls. Runners' Association members averaged far more exercise minutes per week (314 versus 123, p 0.05) than controls. Ever-Runners were younger (62 versus 66 years, 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.

/pdf/aerobic-exercise-and-its-impact-on-musculoskeletal-pain-in-4cbn7pdx54.pdf

Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study

Systemic lupus erythematosus (SLE) is a disease with varied manifestations involving multiple organ systems, accompanied by multiple laboratory abnormalities, and characterized by exacerbations and remissions. Noting that 'uniform classification of defined groups of patients is necessary in order to assemble and compare data from different sources concerning natural history, evaluation of therapy, and epidemologic description', the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association recently approached the formidable task of assembling criteria for the classification of SLE (Cohen, Reynolds, Franklin, Kulka, Ropes, Shulman, and Wallace, 1971). To increase the utility of the criteria in population studies, the use of 'exclusions' and 'duration of manifestations' was avoided. A distinction between 'major' and 'minor' criteria was also not used. Thus, the form of these criteria differs from that of the Jones Criteria for Rheumatic Fever and the ARA Criteria for Rheumatoid Arthritis (Arthritis Foundation, 1964). The committee collected a data base of 245 patients with unequivocal SLE, 234 patients with rheumatoid arthritis, and 217 patients with miscellaneous nonrheumatic diseases. Data was contributed by 52 investigators throughout the United States, who were requested to submit patients with 'unequivocal' SLE, and with 'classic' or 'definite' rheumatoid arthritis. Patients whose clinical course was atypical or in whom diagnostic uncertainty remained were excluded from these two groups. Data was sought on 74 variables of disease considered of potential value for classification. Adequate data was obtained on 57 potential criteria, and the list was reduced to 21 by exclusion of variables which were least useful in distinguishing patients with 'SLE' from 'RA' and 'other' diseases. The final 21 variables were reduced to fourteen 'criteria' by grouping several variables within a single criterion (Table 1, overleaf). The criteria were then tested against the data base, by simple reclassification. A level offour or more positive criteria best distinguished the populations and was recommended by the committee. Tested against the same populations, this level included approximately 90 per cent. ofthe patients with 'SLE' and excluded all but 1 per cent. of the patients with 'rheumatoid arthritis' and all but 2 per cent. of the patients with 'other' diseases. This study evaluates the proposed criteria in the context of five questions: (1) How representative was the ARA test patient population? (2) How adequate are the criteria when tested against an 'outside' patient population? (3) How much does the sensitivity and specificity of the criteria depend upon the point in the course of the patient's illness at which they are applied? (4) How much 'interdependence' is present between various criteria and how much effect does this have on the performance of the criteria? (5) Which diseases might exhibit four or more positive criteria and what percentage of the time may such 'false positives' be expected? Two concepts useful for the testing of criteria are proposed: (1) Testing against a computer-based clinical databank, (2) Testing against 'simulated' patient populations created by computer from known characteristics of the population.

https://ard.bmj.com/content/annrheumdis/32/2/171.full.pdf

Testing the 'preliminary criteria for classification of SLE'.

RENAL disease is a frequent cause of death in scleroderma.1 2 3 4 Renal function can change either gradually or abruptly with the onset of a syndrome similar to malignant hypertension.4 This syndrome of severe uncontrolled hypertension and rapidly progressive renal failure (scleroderma renal crisis) had been considered uniformly and rapidly fatal1 , 4 5 6 7 8 9 until Richardson6 described a patient who survived after nephrectomy and hemodialysis. Subsequently, several patients have survived with hemodialysis or renal transplantation (or both) — often with bilateral nephrectomy as well. Long-term survival has not been reported with only medical antihypertensive therapy of scleroderma renal crisis.10 The present report documents our experience . . .

James F. Fries

Papers

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

Successful aging—an emerging paradigm of gerontology

Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study

Testing the 'preliminary criteria for classification of SLE'.

Successful Medical Treatment of Scleroderma Renal Crisis