Rheumatoid arthritis (RA) patients with unstable and fluctuating disease activity have been shown to be at risk of structural damage progression. Despite considerable efforts dedicated to the assessment of RA disease activity, no consensual definition of RA flare has been achieved.
To define RA flare is challenging since patients and physicians have different perceptions with regards to flare of the disease.
Patients are likely to disentangle “bad days” which are considered as part of the natural history of RA and RA flare which corresponds to the extension of such “bad days”. In the patient perspective, subjective symptoms – fatigue, irritability, pain – are more valued than joint swelling.
Physicians usually base their opinion of flare on physical examination – joint pain or swelling – or biologic results.
To get a more consensual definition of RA flare could be useful for 2 main reasons: 1) the overall assessment of disease stability over the period between 2 medical consultations; 2) the possibility to change the schedule of medical visits depending on the presence or absence of RA flare.
A tool, named FLARE-RA, has been developed to reach this goal. It is a self-administered questionnaire developed to detect rheumatoid arthritis (RA) flare that has occurred in the meantime since the last visit to the physician1. The questionnaire is based on 11 items or statements exploring both RA patients and physician perceptions of RA flare in the 3-month period before the consultation to the rheumatologist. The respondents are asked to rate their agreement on a 0-10 numerical rating scale (NRS). The final score is the mean of the 12 NRS.
The FLARE-RA tool has already been shown to be unidimensional and reliable. The final score displays good correlation with disease activity at the time of questionnaire filling. In addition, it also has fair to good correlation with the overall disease activity – assessed by weekly RAPID-3 – over the 3 months preceding the medical consultation.
The FLARE-RA tool is an interesting and relevant self-administered questionnaire, able to detect past or present RA disease activity increase, i.e., an RA flare. Its predictive validity – in terms of structural damage progression – still needs to be assessed.
Disclosure of Interest B. Fautrel Grant/Research support from: AbbVie, MSD, NORDIC Pharma, Consultant for: AbbVie, BMS, MSD, NORDIC Pharma, Pfizer, Roche, UCB
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