Rheumatoid Arthritis Flare Descriptions May Vary Due to Patient Factors, Flare Timing

A study in the  Journal of Rheumatology sought to standardize and identify variability in patients’ descriptions of arthritic flares. Despite consensus on the domains of what constitutes a flare in patients with rheumatoid arthritis (RA), according to Gabriela L. Maica and colleagues, there continue to be variations in patient descriptions of these experiences.

The investigators utilized prospectively collected data from a rheumatoid arthritis (RA) registry. Participants completed the Disease Activity Score in 28 Joints (DAS28) with C-reactive protein, as well as a qualitative survey which featured an open-ended question asking, “What does a flare mean to you?” The investigators categorized the responses according to the Outcome Measures in Rheumatology (OMERACT) Core and Research domains, and then conducted univariate analyses to identify variables that were independently associated with variation in the flare descriptions.

The OMERACT outcome sets were developed to help identify and measure patient and disease-related factors of rheumatoid arthritis. Domains (e.g., pain, function, sleep, emotional well-being) are selected and validated through systematic review of RA literature.

In total, 645 individuals completed the survey. The median Disease Activity Score in 28 joints (DAS28) with C-reactive protein was 2.1 (interquartile range: 1.6–2.9). In the 6 months prior to filling out the survey, 58% of participants had at least one RA flare.
Regarding qualitative descriptions of flares, participants reported a median of 3 OMERACT domains when descripting flares. Women were more likely to report fatigue (odds ratio [OR]: 6.12; P<.001), and older age was associated with a lower likelihood of emotional distress (OR: 0.97; P=.03), swollen joints (OR: 0.99; P=.04), physical function decrease (OR: 0.98; P=.03), and increased RA symptoms (OR: 0.98; P=.005).
A higher DAS28 score was associated with a lower likelihood of stiff joints (OR: 0.70; P=.009). Participants who experienced a flare within the last 6 months were more likely to report pain (OR: 2.53; P<.001) and fatigue (OR: 2.00; P=.007).

In conclusion, the authors wrote, “Variations in patients’ flare descriptions can be driven by a patient’s disease activity, the experience of a recent flare, as well as different demographic characteristics, such as age and gender.” They added that “understanding the interplay of these characteristics can guide a physician’s approach to the management of patients’ RA flares.”