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.

Our aim has been to determine the relationship between long term physical activity (running) and the number and type of fractures occurring in 906 subjects. Analysis focused on the fractures which occurred during the last 10 years of observation in 722 subjects over the age of 55 years (456 runners and 266 nonrunners). Male and female runners had more fractures than nonrunners, mainly in the lower extremity. Men with a high body mass had fewer total fractures and fewer arm fractures than those with a lower body mass. Men and women with a high calcium intake had fewer fractures from falls than those with a low calcium intake. Fewer fractures from falls occurred in women the longer they had been taking hormones.

Physical activity and fractures over the age of fifty years.

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.

Exercise and the Health of the Elderly.

Background Data are sparse on the association of cardiovascular health (CVH) in younger/middle age with the incidence of dementia later in life. Methods and Results We linked the CHA (Chicago Heart...

/pdf/favorable-cardiovascular-health-at-young-and-middle-ages-and-3tnk2p8bnf.pdf

Favorable Cardiovascular Health at Young and Middle Ages and Dementia in Older Age-The CHA Study.

Part 2: Treatment Approaches

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 < 0005, and most were < 00001 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

James F. Fries

Papers

Physical activity and fractures over the age of fifty years.

Exercise and the Health of the Elderly.

Favorable Cardiovascular Health at Young and Middle Ages and Dementia in Older Age-The CHA Study.

Part 2: Treatment Approaches

Potential and Actual Workdays Lost Among Patients with Hiv