Pain and Self-reported Swollen Joints Are Main Drivers of Patient-reported Flares in Rheumatoid Arthritis: Results from a 12-month Observational Study

OBJECTIVE: To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA).

METHODS: Consecutive RA patients with DAS28CRP<3.2 and no swollen joints were examined at baseline, month 6 and 12. Assessments included joint counts, DAS28-CRP, visual analogue scaleevaluator global assessment (EGA) and PROs. Every third month, patients completed the FLARERA and RA Flare Questionnaire (RA-FQ), 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, PROs and treatment escalation were explored.

RESULTS: Among 80 RA patients (74% females, mean(SD) age 63(10) years, disease duration 11(7) years and baseline DAS28-CRP 1.9(0.6)), 64(80%) reported flare at least once during 12 months. 55% of flares lasted less than one 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 PROs 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 1.30;2.60]), patient-reported swollen joints (OR 1.18 [1.03;1.36]), and higher EGA (OR 1.15 [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.