James F. Fries

Bio: James F. Fries is an academic researcher from Stanford University. The author has contributed to research in topics: Rheumatoid arthritis & Arthritis. The author has an hindex of 100, co-authored 369 publications receiving 83589 citations. Previous affiliations of James F. Fries include University of Saskatchewan & National Institutes of Health.

Patient Education and Health Promotion Can Be in Parkinson's Disease: A Randomized Controlled

Abstract: We performed a randomized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson’s disease. The health promotion program (PROPATH) was designed to improve health confidence, provide information and support, improve physical function through exercise, and work with the physician to optimize medical treatment and compliance. The intervention was delivered by mail, with disease assessment questionnaires completed by patient or caregiver at 0, 2, 4, and 6 months, with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians. Two hundred ninety patients completed the 6-month trial, 140 patients in the intervention group and 150 in a control group of patients who received only questionnaires. The intervention group had significantly increased exercise, decreased “time off” and percentage of time off, reduced side effects, and decreased summary Parkinson’s scores by approximately 10% (P >0.05). Twelve of 13 variables showed differences favoring the intervention group. The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise sharply for controls (P ~0.01). Levodopa dose rose for controls and slightly decreased for the intervention group. Doctor visits, hospital days, and sick days were reduced in the intervention group. The quality-of-life

Rheumatologist perceptions of sources of health care disparities in minority rheumatoid arthritis patients.

Abstract: Disparities in health outcomes among minority patients persist and in some patients have worsened. A large body of evidence indicates minority differences in all-cause mortality, chronic disease prevalence, and poorer functional status. When compared with nonminority rheumatoid arthritis (RA) patients, minority counterparts have poorer health outcomes, including worse disability and pain and a poorer overall health perception. Genetics, socioeconomic, cultural, behavioral, and intraindividual factors, as well as their interactive effects, have been documented as potential contributors to inequities across numerous diseases and conditions between Whites and minority groups. The study of socioeconomic factors, such as education and income, has predominated, but independently has not completely explained the reasons for disparities, even after statistical adjustment. A patient’s mistrust of the physician or the health care system, inadequate access or use of the health care system, low health literacy, language barriers, and treatment refusal are also among possible forces. In addition, provider-patient factors, including prejudice, stereotyping, and ambiguity surrounding minority patient interactions have been posited as contributors to disparities in medical treatment and health outcomes. Reasons for these disparities among minority RA patients are largely unexplored, although substantial data demonstrate that minorities are disproportionately affected by the consequences of arthritis. Because arthritis and other rheumatic conditions are projected to increase to a quarter of the adult population by 2030, examination of relevant factors that contribute to health disparities is needed. The purpose of this exploratory study was to survey rheumatologist perceptions of behaviors, beliefs, and attitudes related to treatment and health outcomes of minority RA patients.

Osteoarthritis, exercise, and knee replacement.

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

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

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.

The 1982 revised criteria for the classification of systemic lupus erythematosus

Abstract: 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.

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

Abstract: 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).

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

Abstract: 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.