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FREDERICK WOLFE
ABSTRACT. Key Indexing Terms:
DATA BANKS
From the National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation and the University of Kansas School of Medicine, Wichita, Kansas, USA. F. Wolfe, MD. Address reprint requests to Dr. F. Wolfe, National Data Bank for Rheumatic Diseases, 1035 N. Emporia, Suite 230, Wichita, KS 67214. E-mail: fwolfe@arthritis-research.org The formal start of data banking in the United States began with the proposal by James Fries for a common language of rheumatology that might be used in data banking1. This was followed closely by the founding by Fries of the ARAMIS (American Rheumatism Association Medical Information System — later the Arthritis, Rheumatism and Aging Medical Information System)2-4. Although Fries put together the first computer-based rheumatology data bank, the first true data collectors were Donald Mitchell, MD, of Saskatchewan and Joseph Levinson, MD, of Cincinnati. Mitchell was an adult rheumatologist who in the 1960s began collecting on paper exquisitely detailed data on all of his patients and clinical encounters5-7. Levinson, a pediatric rheumatologist, collected similar paper data on his patients8. Fred Wolfe, a rheumatologist in Wichita, Kansas, was the first rheumatologist (1974) to collect computerized data on patients seen in a clinical practice. In Pittsburgh, Dr. Tom Medsger brought his previously defined scleroderma data bank into the ARAMIS envelope in the decade of the 1970s with publications generally beginning in the 1980s9-11. ARAMIS It was Fries and his colleagues at Stanford University, however, who built the ARAMIS computerized data bank, making it accessible to multiple users throughout the US by the use of telephone networks. In addition, they incorporated into ARAMIS programs for data analysis. ARAMIS also attempted to implement a standardized language that could be used by all rheumatologists1,4. However, this attempt at a lingua Franca was not successful as there were many different methods for assessments, and the newly proposed methods were not universally agreed on or backward compatible. Major changes in the direction of compatibility came about later with the incorporation of self-report measures and standardized examination measures into the American College of Rheumatology core criteria for clinical trials12,13. Supported by US National Institutes of Health (NIH) grants for more than 25 years, ARAMIS was the first research rheumatology data bank. Around 1980, funding from an outside source, the manufacturer of auranofin, provided enough supplemental funds to bring together online, as part of ARAMIS, the data banks of Mitchell, Levinson, Wolfe, and Sanford Roth of Phoenix. These were known as the Saskatchewan, Cincinnati, Wichita, Phoenix, and Pittsburgh data banks. Together with the data bank from the Stanford clinics (Stanford) and a community data bank formed by the Stanford group (Santa Clara), these sources formed more than 90% of the activity and data encompassed in the ARAMIS system over most of its life14,15. There was a small contribution from Cincinnati adult rheumatology, and in the mid 1980s Phoenix stopped its primary data collection. ARAMIS might be thought of, then, as an adult, primarily rheumatoid arthritis (RA) data group composed of Stanford, Santa Clara, Saskatchewan, and Wichita through the late 1990s. Wichita left ARAMIS at that time, while another RA group from Pittsburgh joined to contribute data. Although the ARAMIS system worked well in RA, none of the other centers could supply enough patients with scleroderma, juvenile RA (JRA), or systemic lupus erythematosus — except Pittsburgh (scleroderma) and Cincinnati (JRA) — to make a substantive consortium; gradually these specialty data banks faded away within the ARAMIS system. The major accomplishment of ARAMIS in these areas was to provide motivation and expertise that allowed the specialty centers to develop their own data banks. Although a number of "ARAMIS publications" followed from the specialist data banks, these were specialty reports rather than ARAMIS consortium reports. In contrast to work by the early contributors to ARAMIS whose data sets contained physical examination, laboratory, and radiographic data, the ARAMIS assessment model utilized only questionnaire data that was obtained at 6-month intervals. Hence one of the limitations of ARAMIS (and all data banks that followed on this model) was the lack of clinical data. It became impossible to measure or document the kind of changes that occur in the clinic, or to link results to physical examination or laboratory data. By contrast the biannual questionnaire was superbly positioned to measure costs and longterm outcomes. CLINICAL DATA MODELS In the 1980s Ted Pincus started data collection using primarily the clinical model16-30. He and Fred Wolfe stayed with the clinical data model31-52, although Wolfe also participated in the biannual data collection of ARAMIS53-61. The ARAMIS model was enormously successful, producing a series of important papers in rheumatology. The clinical model was pursued by Pincus and Wolfe, who also published many influential reports16-52. In 1992, Dr. Hal Paulus at UCLA incorporated the ARAMIS survey methods and the clinical practice method. The Consortium of Practicing Rheumatologists (The Western Consortium) was formed in 1992 as part of an NIH-sponsored Multipurpose Arthritis and Musculoskeletal Diseases Center grant to study early severe RA. The description that follows was provided by Paulus and modified by the author as necessary. At the inception of the Western Consortium 51 community physician-investigators were recruited, while an additional 20 have joined subsequently. Forty-four have enrolled at least one patient, while 40 physicians in 25 geographical locations in the Western United States have actively followed patients through June 2002. Physicians in the study regularly see and treat patients at the onset of their RA. Information is collected about these patients as they are treated by their physicians, from the beginning of their RA for 2 to 5 or more years (up to 15 or 20 years, if possible), to see whether joint damage is related to the presence of certain characteristics within one year of the start of the RA, and whether treatment can prevent joint damage. This evaluation is based on radiographs of hands, wrists and feet, physical examination of the joints, recording of RA symptoms, and functional status and erythrocyte sedimentation rate (ESR) at the beginning of the study, after 6 and 12 months, and yearly thereafter. All of these are a part of ordinary RA care and are done by the patient's personal rheumatologist and paid for by the patient or the insurer. The Western Consortium merely collects the information and compares it among patients. In addition, they collect extra blood for genetic testing to see if the inherited rheumatoid epitope can be used to predict joint damage, and for storing in freezer banks for future evaluation of new tests. The rheumatologists can treat their RA patients however they choose. The physician and the patient decide which treatment to use and when to change treatments, depending on their individual assessments of the benefits and risks. By mid 2002, 326 patients had been enrolled. The first patient entered January 28, 1993, and the most recent on April 1, 2002. A total of 70 patients have withdrawn at their own request or because their consortium doctor moved or stopped participating in the study. Patients who enter the study receive individualized "best care" by their personal rheumatologists, which includes evaluating at entry, 6 months, 12 months, and yearly thereafter (and whenever the initial treatment regimen is stopped): radiographs of hands, wrists, and feet; physical examination to evaluate joint tenderness and swelling, and hand grip strength (measured by squeezing a partially inflated sphygmomanometer bag); history of morning stiffness, hours to onset of fatigue, subjective pain intensity, and functional status by health assessment questionnaires; and Westergren ESR. In addition to these items involved in rheumatologic care of RA, the Consortium asks for 30 cc of heparinized blood at baseline to be used to test for the genetic "susceptibility epitope" and to be used to establish a freezer bank. Information is collected by direct patient questionnaire and followup telephone calls regarding RA status, functional status, ability to work, dependence on others, and RA-associated costs. The Western Consortium has been a successful project, with a continuing publication record62-68. However, the 71 rheumatologists have enrolled only 326 patients in a 10-year period. This illustrates the difficulty that many have found in relying on community physicians to enroll and follow patients in the detail required. LIMITATIONS Problems also occurred with the ARAMIS model and the clinical model of Pincus and Wolfe. The ARAMIS experiment might have been expected to stimulate others to build additional large data banks in the 30 years that it has been in existence. But this did not occur. Similarly, Pincus and Wolfe engendered no followers. Other defects occurred with these systems. Although ARAMIS was designed to be a national data base system, it really had only a few active centers, as noted above. With time, patients registered within the system aged or died, and the average age and duration of disease of the patients in the data bank rose. Only a small percentage of those enrolled in the ARAMIS data banks remain active participants. The idea that longitudinal survey data banks could answer many questions of importance was most true in eras when therapy was not very effective so that one could infer results from decade to decade. With the introduction of cyclooxygenase-2 inhibitor drugs and then anti-tumor necrosis factor (TNF) agents much of the older data in longitudinal data banks lost most of its value. What good, for example, was the enormous experience with gold therapy if it was no longer a viable therapy? These problems also were noted with the Pincus and Wolfe clinical models, where aging populations and changes in therapies and laboratory tests created the same problems as in the ARAMIS system. In the late 1990s, Wolfe developed in ARAMIS an inception cohort of almost 1000 patients. But unlike the original ARAMIS model, where the data bank managers were patients' physicians, this inception cohort made use of referring rheumatologists. This method did not work well, and within 5 years only 35–40% of the inception cohort remained in the study, despite intensive effort to retain them69,70. Recently, Pincus and Sokka started an early RA data bank, and are actively enrolling new patients. In 1998, Wolfe started the National Data Bank for Rheumatic Diseases (NDB)71. The goal of the NDB was to enroll a large number of patients from a group of geographically diverse rheumatologists. By 2003, the NDB had enrolled 23,319 patients, including 18,501 with RA, 3774 with osteoarthritis, and 1044 with fibromyalgia. Each of these patients had completed at least one detailed survey questionnaire. These patients came from the practices of 904 US rheumatologists and had, as might be expected, had wide exposure to contemporary therapy with anti-TNF and coxib agents. The NDB questionnaires have as their original model the ARAMIS type questionnaire, but in the NDB administration the questionnaire had been expanded to incorporate additional cost and outcome items, all drugs, and a variety of detailed quality of life instruments. The large cross-sectional data bank together with the contemporary longitudinal data have made the NDB a valuable public health and clinical research tool33,72-84. The NDB has also been used for teaching rheumatology fellows using programs written by NDB staff to mine the data. 1. Fries JF, Hess EV, Klinenberg J. A standard database for rheumatic diseases. Arthritis Rheum 1974;17:327-36. 2. Fries JF. A data bank for the clinician? [editorial]. N Engl J Med 1976;294:1400-2. 3. Weyl S, Fries J, Wiederhold G, Germano F. A modular self-describing clinical databank system. Comput Biomed Res 1975;8:279-93. 4. Fries JF. Alternatives in medical record formats. Med Care 1974;12:871-81. 5. Mitchell DM, Spitz PW, Young DY, Bloch DA, McShane DJ, Fries JF. Survival, prognosis and causes of death in rheumatoid arthritis. Arthritis Rheum 1986;29:706-14. [MEDLINE] 6. Mitchell DM, Fries JF. An analysis of the American Rheumatism Association criteria for rheumatoid arthritis. Arthritis Rheum 1982;25:481-7. [MEDLINE] 7. Fries JF, Mitchell DM. Joint pain or arthritis. JAMA 1976;235:199-204. 8. Levinson JE. The ideal program for juvenile arthritis. Arthritis Rheum 1977;20 Suppl:607-10. 9. Steen VD, Blair S, Medsger TA Jr. The toxicity of D-penicillamine in systemic sclerosis. Ann Intern Med 1986;104:699-705. [MEDLINE] 10. Steen VD, Medsger TA Jr, Rodnan GP. D-penicillamine therapy in progressive systemic sclerosis (scleroderma): a retrospective analysis. Ann Intern Med 1982;97:652-9. [MEDLINE] 11. Masi AT, Rodnan GP, Medsger TA Jr, et al. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980;23:581-90. [MEDLINE] 12. Felson DT. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis: Comment – Reply. Arthritis Rheum 1996;39:536-7. 13. Felson DT, Anderson JJ, Boers M, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum 1993;36:729-40. [MEDLINE] 14. Wolfe F, Fries JF. ARAMIS today: moving toward internationally distributed databank systems for follow-up studies. Clin Rheumatol 1987;6 Suppl 2:93-102. 15. Fries JF. The chronic disease data bank: first principles to future directions. J Med Philos 1984;9:161-80. [MEDLINE] 16. Pincus T, Wolfe F. Treatment of rheumatoid arthritis: challenges to traditional paradigms [editorial]. Ann Intern Med 1991;115:825-7. [MEDLINE] 17. Pincus T, Brooks RH, Callahan LF. Reliability of grip strength, walking time and button test performed according to a standard protocol. J Rheumatol 1991;18:997-1000. [MEDLINE] 18. Callahan LF, Pincus T. Associations between clinical status questionnaire scores and formal education level in persons with systemic lupus erythematosus. Arthritis Rheum 1990;33:407-11. [MEDLINE] 19. Callahan LF, Smith WJ, Pincus T. Self report questionnaires in five rheumatic diseases: Comparisons of health status constructs and associations with formal education level. Arthritis Care Res 1989;2:122-31. [MEDLINE] 20. Fuchs HA, Brooks RH, Callahan LF, Pincus T. A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum 1989;32:531-7. [MEDLINE] 21. Pincus T, Callahan LF. Clinical use of multiple nonsteroidal antiinflammatory drug preparations within individual rheumatology private practices. J Rheumatol 1989;16:1253-8. [MEDLINE] 22. Pincus T, Callahan LF, Brooks RH, Fuchs HA, Olsen NJ, Kaye JJ. Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic, and laboratory measures. Ann Intern Med 1989;110:259-66. [MEDLINE] 23. Brooks RH, Callahan LF, Pincus T. Use of self-report activities of daily living questionnaires in osteoarthritis. Arthritis Care Res 1988;1:23-32. 24. Callahan LF, Brooks RH, Pincus T. Further analysis of learned helplessness in rheumatoid arthritis using a Rheumatology Attitudes Index. J Rheumatol 1988;15:418-26. [MEDLINE] 25. Fuchs HA, Callahan LF, Kaye JJ, Brooks RH, Nance EP, Pincus T. Radiographic and joint count findings of the hand in rheumatoid arthritis. Related and unrelated findings. Arthritis Rheum 1988;31:44-51. [MEDLINE] 26. Pincus T. Rheumatoid arthritis: disappointing long-term outcomes despite successful short-term clinical trials. J Clin Epidemiol 1988;41:1037-41. [MEDLINE] 27. Pincus T, Callahan LF, Vaughn WK. Questionnaire, walking time and button test measures of functional capacity as predictive markers for mortality in rheumatoid arthritis. J Rheumatol 1987;14:240-51. [MEDLINE] 28. Pincus T, Callahan LF. Formal education as a marker for increased mortality and morbidity in rheumatoid arthritis. J Chron Dis 1985;38:973-84. [MEDLINE] 29. Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE, Vaughn WK. Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 1984;27:864-72. [MEDLINE] 30. Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 1983;26:1346-53. [MEDLINE] 31. Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F. Methotrexate therapy and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002;359:1173-7. [MEDLINE] 32. Wolfe F, van der Heijde DM, Larsen A. Assessing radiographic status of rheumatoid arthritis: introduction of a short erosion scale. J Rheumatol 2000;27:2090-9. [MEDLINE] 33. Wolfe F, Hawley DJ. The comparative risk and predictors of adverse gastrointestinal events in rheumatoid arthritis and osteoarthritis: A prospective 13 year study of 2131 patients. J Rheumatol 2000;27:1668-73. [MEDLINE] 34. Wolfe F, Zwillich SH. The long-term outcomes of rheumatoid arthritis: A 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum 1998;41:1072-82. [MEDLINE] 35. Wolfe F, Sharp JT. Radiographic outcome of recent-onset rheumatoid arthritis: A 19-year study of radiographic progression. Arthritis Rheum 1998;41:1571-82. [MEDLINE] 36. Wolfe F, Hawley DJ. The long-term outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients. J Rheumatol 1998;25:2108-17. [MEDLINE] 37. Wolfe F. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis. J Rheumatol 1997;24:1477-85. [MEDLINE] 38. Wolfe F, Hawley DJ. Measurement of the quality of life in rheumatic disorders using the EuroQol. Br J Rheumatol 1997;36:786-93. [MEDLINE] 39. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 1996;23:1407-17. [MEDLINE] 40. Wolfe F, Michaud K. The clinical and research significance of the erythrocyte sedimentation rate. J Rheumatol 1994;21:1227-37. [MEDLINE] 41. Wolfe F, Hawley DJ, Cathey MA. Measurement of gold treatment effect in clinical practice: evidence for effectiveness of intramuscular gold therapy. J Rheumatol 1993;20:797-802. [MEDLINE] 42. Wolfe F, Hawley DJ. The relationship between clinical activity and depression on rheumatoid arthritis. J Rheumatol 1993;20:2032-7. [MEDLINE] 43. Sharp JT, Wolfe F, Mitchell DM, Bloch DA. The progression of erosion and joint space narrowing scores in rheumatoid arthritis during the first 25 years of disease. Arthritis Rheum 1991;34:660-8. [MEDLINE] 44. Wolfe F, Cathey MA. Analysis of methotrexate treatment effect in a longitudinal observational study: utility of cluster analysis. J Rheumatol 1991;18:672-7. [MEDLINE] 45. Wolfe F, Cathey MA, Hawley DJ. Improvement in gold treated rheumatoid arthritis patients: a second look at gold effectiveness in the community [abstract]. Arthritis Rheum 1991;34 Suppl:S53. 46. Wolfe F, Hawley DJ, Cathey MA. The assessment and prediction of functional disability in RA. J Rheumatol 1991;18:1298-306. [MEDLINE] 47. Wolfe F, Hawley DJ, Cathey MA. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: a 14-year prospective evaluation of 1017 consecutive starts. J Rheumatol 1990;17:994-1002. [MEDLINE] 48. Wolfe F, Kleinheksel SM, Khan MA. Familial vs sporadic rheumatoid arthritis: a comparison of the demographic and clinical characteristics of 956 patients. J Rheumatol 1988;15:400-4. [MEDLINE] 49. Wolfe F, Cathey MA. The epidemiology of tender points: A prospective study of 1520 patients. J Rheumatol 1985;12:1164-8. [MEDLINE] 50. Wolfe F, Hawley DJ. Remission in rheumatoid arthritis. J Rheumatol 1985;12:245-52. [MEDLINE] 51. Wolfe F, Cathey MA, Kleinheksel SM, et al. Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis. J Rheumatol 1984;11:500-6. [MEDLINE] 52. Wolfe F, Cathey MA. Prevalence of primary and secondary fibrositis. J Rheumatol 1983;10:965-8. [MEDLINE] 53. Albert DA, Aksentijevich S, Hurst S, Fries JF, Wolfe F. Modeling therapeutic strategies in rheumatoid arthritis: Use of decision analysis and Markov models. J Rheumatol 2000;27:644-52. [MEDLINE] 54. Williams CA, Bloch DA, Sibley J, et al. Lymphoma and leukemia in rheumatoid arthritis: are they associated with azathioprine, cyclophosphamide, or methotrexate? A matched case-control study in the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) population. J Clin Rheumatol 1996;2:64-72. 55. Wolfe F, Mitchell DM, Sibley JT, et al. The mortality of rheumatoid arthritis. Arthritis Rheum 1994;37:481-94. [MEDLINE] 56. Michel BA, Bloch DA, Wolfe F, Fries JF. Fractures in rheumatoid arthritis: an evaluation of associated risk factors. J Rheumatol 1993;20:1666-9. [MEDLINE] 57. Sherrer YS, Bloch DA, Mitchell DM, Roth SH, Wolfe F, Fries JF. Disability in rheumatoid arthritis: comparison of prognostic factors across three populations. J Rheumatol 1987;14:705-9. [MEDLINE] 58. Fries JF, Spitz PW, Mitchell DM, Roth SH, Wolfe F, Bloch DA. Impact of specific therapy upon rheumatoid arthritis. Arthritis Rheum 1986;29:620-7. [MEDLINE] 59. Lubeck DP, Spitz PW, Fries JF, Wolfe F, Mitchell DM, Roth SH. A multicenter study of annual health service utilization and costs in rheumatoid arthritis. Arthritis Rheum 1986;29:488-93. [MEDLINE] 60. Wolfe F, Kleinheksel SM, Spitz PW, et al. A multicenter study of hospitalization in rheumatoid arthritis. Frequency, medical-surgical admissions, and charges. Arthritis Rheum 1986;29:614-9. [MEDLINE] 61. Wolfe F, Kleinheksel SM, Spitz PW, et al. A multicenter study of hospitalization in rheumatoid arthritis: effect of health care system, severity, and regional difference. J Rheumatol 1986;13:277-84. [MEDLINE] 62. Paulus HE, Wiesner J, Bulpitt KJ, et al. Autoantibodies in early seropositive rheumatoid arthritis, before and during disease modifying antirheumatic drug treatment. J Rheumatol 2002;29:2513-20. [MEDLINE] 63. Newhall-Perry K, Law NJ, Ramos B, et al. Direct and indirect costs associated with the onset of seropositive rheumatoid arthritis. Western Consortium of Practicing Rheumatologists. J Rheumatol 2000;27:1156-63. [MEDLINE] 64. Paulus HE, Bulpitt KJ, Ramos B, Park G, Wong WK. Relative contributions of the components of the American College of Rheumatology 20% criteria for improvement to responder status in patients with early seropositive rheumatoid arthritis. Arthritis Rheum 2000;43:2743-50. [MEDLINE] 65. Munster T, Paulus HE, Clements PJ, Bulpitt KJ, Wong WK, Furst DE, Western Consortium of Practicing Rheumatologists. Abbreviated joint counts are as sensitive as more complete joint counts when testing response using ACR response criteria (ACR 20 and ACR 50) [abstract]. Arthritis Rheum 1999;42 Suppl:1670. 66. Paulus HE, Ramos B, Wong WK, et al. Equivalence of the acute phase reactants C-reactive protein, plasma viscosity, and Westergren erythrocyte sedimentation rate when used to calculate American College of Rheumatology 20% improvement criteria or the Disease Activity Score in patients with early rheumatoid arthritis. Western Consortium of Practicing Rheumatologists. J Rheumatol 1999;26:2324-31. [MEDLINE] 67. Wong AL, Wong WK, Harker J, et al. Patient self-report tender and swollen joint counts in early rheumatoid arthritis. J Rheumatol 1999;26:2551-61. [MEDLINE] 68. Berkanovic E, Oster P, Wong WK, et al. The relationship between socioeconomic status and recently diagnosed rheumatoid arthritis. Arthritis Care Res 1996;9:257-62. [MEDLINE] 69. Fries JF, Wolfe F, Apple R, et al. HLA-DRB1 genotype associations in 793 white patients from a rheumatoid arthritis inception cohort: frequency, severity, and treatment bias. Arthritis Rheum 2002;46:2320-9. [MEDLINE] 70. Wolfe F, Pincus T, Fries JF. Use of second line "disease modifying" anti-rheumatic drugs (DMARDs) within 5 months of disease onset by 64% of 750 rheumatoid arthritis patients under the care of 142 US rheumatologists: an inception cohort study [abstract]. Arthritis Rheum 1997;40 Suppl:S218. 71. Wolfe F, Flowers N, Anderson J. The National Rheumatic Disease Data Bank: case mix and severity characteristics of patients in rheumatological practice [abstract]. Arthritis Rheum 1998;41 Suppl:S132. 72. Wolfe F. Pain extent and diagnosis: development and validation of the Regional Pain Scale in 12,799 patients with rheumatic disease. J Rheumatol 2003;30:369-78. [MEDLINE] 73. Wolfe F, Freundlich B, Straus WL. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 2003;30:36-40. [MEDLINE] 74. Ethgen O, Kahler KH, Kong SX, Reginster JY, Wolfe F. The effect of health related quality of life on reported use of health care resources in patients with osteoarthritis and rheumatoid arthritis: a longitudinal analysis. J Rheumatol 2002;29:1147-55. [MEDLINE] 75. Wolfe F, Anderson J, Burke TA, Arguelles LM, Pettitt D. Gastroprotective therapy and risk of gastrointestinal ulcers: risk reduction by COX-2 therapy. J Rheumatol 2002;29:467-73. [MEDLINE] 76. Wolfe F, Flowers N, Burke TA, Arguelles LM, Pettitt D. Increase in lifetime adverse drug reactions, service utilization, and disease severity among patients who will start COX-2 specific inhibitors: quantitative assessment of channeling bias and confounding by indication in 6689 patients with rheumatoid arthritis and osteoarthritis. J Rheumatol 2002;29:1015-22. [MEDLINE] 77. Wolfe F. The psychometrics of functional status questionnaires: room for improvement. J Rheumatol 2002;29:865-8. [MEDLINE] 78. Wolfe F, Pincus T, Tennant A. HAQ-II: Application of modern item response theory to the design of an improved HAQ questionnaire [abstract]. Ann Rheum Dis 2002;61:90. [MEDLINE] 79. Wolfe F. Which HAQ is best? A comparison of the HAQ, MHAQ and RA-HAQ, a difficult 8 item HAQ (DHAQ), and a rescored 20 item HAQ (HAQ20): analyses in 2491 rheumatoid arthritis patients following leflunomide initiation. J Rheumatol 2001;28:982-9. [MEDLINE] 80. Wolfe F, Flowers N, Anderson J, Urbansky K. Tuberculosis rates are not increased in rheumatoid arthritis (RA) [abstract]. Arthritis Rheum 2001;44 Suppl:S105. 81. Wolfe F, Choi HK. Benchmarking and the percentile assessment of RA: adding a new dimension to rheumatic disease measurement. Ann Rheum Dis 2001;60:994-5. [MEDLINE] 82. Wolfe F. A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum 2000;43:2751-61. [MEDLINE] 83. Wolfe F, Kong SX, Watson DJ. Gastrointestinal symptoms and health related quality of life in patients with arthritis. J Rheumatol 2000;27:1373-8. [MEDLINE] 84. Wolfe F. The importance of gastrointestinal (GI) symptom severity in rheumatoid and osteoarthritis: Symptom rates and risk for GI hospitalization. J Rheumatol 2000;27:1661-7. [MEDLINE] |
