Dorota Kuettel1, Jette Primdahl1, Ulrich Weber1, Lene Terslev1, Mikkel Østergaard1, Randi Petersen1, Andreas Kristian Pedersen1, Sören Möller1, Kim Hørslev-Petersen1. 1. From the Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg; Institute of Regional Health Research, University of Southern Denmark, Odense; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Open Patient data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. This study was supported by the Danish Rheumatism Association, the University of Southern Denmark, the Region of Southern Denmark, and the Knud og Edith Eriksens Mindefond (Knud and Edith Eriksens Memorial Fund). D. Kuettel, MD, PhD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark; J. Primdahl, MSN, PhD, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; U. Weber, MD, Associate Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark, and Hospital of Southern Jutland, University Hospital of Southern Denmark; L. Terslev, MD, PhD, Associate Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup; R. Petersen, MSN, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark; A.K. Pedersen, MS, Hospital of Southern Jutland, University Hospital of Southern Denmark; S. Möller, MS, PhD, Associate Professor, OPEN, Odense University Hospital and Department of Clinical Research, University of Southern Denmark; K. Hørslev- Petersen, MD, DMSc, Professor, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, and Institute of Regional Health Research, University of Southern Denmark. Address correspondence to Dr. D. Kuettel, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, DK-6400 Sønderborg, Denmark. E-mail: Dkuttel@danskgigthospital.dk, dkuettel@health.sdu.dk. Accepted for publication November 8, 2019.
Abstract
OBJECTIVE: To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PRO) in patients with rheumatoid arthritis (RA). METHODS: Consecutive RA patients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) < 3.2 and no swollen joints were examined at baseline, Month 6, and Month 12. Assessments included joint counts, DAS28-CRP, visual analog scale-evaluator's global assessment (EGA), and PRO. Every third month, patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire, and disclosed self-management strategies. Flaring and non-flaring patients were compared and longitudinal associations between self-reported flare status (yes/no) and disease activity, PRO, and treatment escalation were explored. RESULTS: Among 80 patients with RA [74% females, mean (SD) age 63 (10) yrs, disease duration 11 (7) yrs, and baseline DAS28-CRP 1.9 (0.6)], 64 (80%) reported flare at least once during 12 months. Fifty‑five percent of flares lasted less than 1 week. Common self-management strategies were analgesics (50%) and restricted activities (38%). Patients who reported being in flare had consistently higher disease activity measures and PRO compared to patients without flare. In a partly adjusted model, all flare domains, patient-reported swollen and tender joint counts and disease activity measures were associated with flares. In fully adjusted analyses, present flare was independently associated with pain (OR 1.85, 95% CI 1.34-2.60), patient-reported swollen joints (OR 1.18, 95% CI 1.03-1.36), and higher EGA (OR 1.15, 95% CI 1.04-1.28). Treatment escalation was associated with present flare (p ≤ 0.001). CONCLUSION: In RA, self-reported flares were frequent, mainly managed by analgesics, substantiated by higher disease activity measures, independently associated with pain and patient-reported swollen joints, and related to treatment escalation.
OBJECTIVE: To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PRO) in patients with rheumatoid arthritis (RA). METHODS: Consecutive RApatients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) < 3.2 and no swollen joints were examined at baseline, Month 6, and Month 12. Assessments included joint counts, DAS28-CRP, visual analog scale-evaluator's global assessment (EGA), and PRO. Every third month, patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire, and disclosed self-management strategies. Flaring and non-flaring patients were compared and longitudinal associations between self-reported flare status (yes/no) and disease activity, PRO, and treatment escalation were explored. RESULTS: Among 80 patients with RA [74% females, mean (SD) age 63 (10) yrs, disease duration 11 (7) yrs, and baseline DAS28-CRP 1.9 (0.6)], 64 (80%) reported flare at least once during 12 months. Fifty‑five percent of flares lasted less than 1 week. Common self-management strategies were analgesics (50%) and restricted activities (38%). Patients who reported being in flare had consistently higher disease activity measures and PRO compared to patients without flare. In a partly adjusted model, all flare domains, patient-reported swollen and tender joint counts and disease activity measures were associated with flares. In fully adjusted analyses, present flare was independently associated with pain (OR 1.85, 95% CI 1.34-2.60), patient-reported swollen joints (OR 1.18, 95% CI 1.03-1.36), and higher EGA (OR 1.15, 95% CI 1.04-1.28). Treatment escalation was associated with present flare (p ≤ 0.001). CONCLUSION: In RA, self-reported flares were frequent, mainly managed by analgesics, substantiated by higher disease activity measures, independently associated with pain and patient-reported swollen joints, and related to treatment escalation.