Background Domains for assessment of Rheumatoid Arthritis (RA) flare identified by patients (pts) and health care professionals through OMERACT Delphi exercises have included pain, function, stiffness, participation, coping, patient global assessment (PtGAS), fatigue and self-management strategies1.
Objectives To determine how these domains correspond to flare in pts with early RA.
Methods Pts in the Canadian early ArThritis CoHort (CATCH) completed the OMERACT preliminary flare questionnaire (PFQ) at study visits between 11-2011 and 1- 2012. The PFQ asks pts to indicate if they are in a flare (F) or not (NF), the severity of Flare (0-10 NRS), PtGAS, levels of function, fatigue, pain, stiffness, coping, and participation (0-10 NRS), and to describe self-management strategies. At each visit rheumatologists rated whether their pt was in a flare (0-10 (VAS)).
Results Of 263 pts answering the PFQ, 30% (79) reported being in a flare (F) and 70% were not in a flare (NF). Mean age (SD) in Flare group was 52.3 (16.6); 77% were female and 68.4% were RF+. RA symptom duration at time of flare ranged from <4 to >48 months. 15% of flares lasted 1-3 d, 20% 4-7 d, 12% 8-14 d, and 53% over14 d. Concordance between physicians and pts was low (kappa =0.4114) overall, but more likely with increasing severity of flare domains (Table). 5% of Flare pts sought help from a rheumatologist; 3% increased steroid doses; 58% used analgesics, and 48% reduced activities. Most used ≥1 self management strategy.
Conclusions Flares are common in early RA and agreement between patients and rheumatologists as to whether they were in a flare was low overall. Concordance is highest and directly related to increasing severity of patient reported outcomes (PROs) (pain, function, stiffness, coping, participation, PtGAS, and fatigue). PROs across multiple domains during flares are consistent with focus group, Delphi and results of others identifying heterogeneity of symptoms reported by patients when defining flare. These real life data in an early RA cohort also suggest that multiple approaches to self-management are attempted by RA pts experiencing a flare before visiting their physician.
Bartlett SJ, et al.,Arthritis Rheum 2011;63(suppl):128.
Disclosure of Interest V. Bykerk Grant/Research support from: CATCH Study is supported by unrestricted research grants from Amgen, Pfizer, Abbott, BMS, Janssen, Roche, UCB, S. Bartlett: None Declared, E. Choy: None Declared, G. Boire: None Declared, C. Hitchon: None Declared, J. Pope: None Declared, C. Thorne: None Declared, B. Haraoui: None Declared, E. Keystone: None Declared, C. Bingham III: None Declared