Background Flares - episodes of worsening in disease activity - are common features in patients with rheumatoid arthritis (RA), even in remission or in low disease activity state. There are different definitions of flare. It is unknown whether patient reported flares lead to suboptimal long-term outcomes.
Objectives To investigate whether transient patient reported flares can influence functional disability in patients with established low active RA.
Methods Out of 287 patients from the AMBRA trial (1), 268 RA patients with low disease activity (DAS28CRP <3.2 and no swollen joints at baseline) and data about flares were included in analyses. The patients were followed for two years and were asked, at annual clinical controls, to recall the occurrence of flares during the past year, according to: no flares, transient flares or persistent joint complaints with tender and swollen joints. Functional capacity was assessed by the Danish version of the Health Assessment Questionnaire (HAQ). The proportion of patients who worsened in HAQ (ΔHAQ> MCID of 0.22) was compared across three groups and the association between flare phenotype and functional outcome was analyzed by logistic regression.
Results 70% were female, median age [IQR] was 63 years [55;70], 73% were rheumatoid factor positive, 71% anti-CCP positive and all had established RA (median [IQR] 7 years [4;13]). Based on the flare questionnaire three groups were distinguished: No-flares group (n=77), transient flares group (n=141) and patients with persistent joint complaints (n=50). Worsening in functional capacity (ΔHAQ>0.22) was seen in 13%, 21% and 40% of patients with no flares, with transient flares and those with persistent joint complaints, respectively (p=0.0015). Compared to the reference group (no flares) worsening in functional capacity was potentially related to “flare phenotype”: OR 1.81 (95%CI: 0.83-3.94, p=0.134) for the transient flare status, and statistically significantly associated with persistent joint complaints OR 2.01 (1.22-3.31, p=0.006).
Conclusions RA patients with established low disease activity, who self-report persistent joint complaints have worse functional outcome compared to patients with transient flares and without flares.
Primdahl J, et al.: Ann Rheum Dis 2014; 73: 357-364.
Disclosure of Interest None declared
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