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A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: The ‘FLARE’ instrument
  1. Jean-Marie Berthelot1,
  2. Michel De Bandt2,
  3. Jacques Morel3,
  4. Fatima Benatig4,5,6,
  5. Arnaud Constantin7,8,
  6. Philippe Gaudin9,
  7. Xavier Le Loet10,
  8. Jean-Francis Maillefert11,
  9. Olivier Meyer12,13,14,
  10. Thao Pham15,
  11. Alain Saraux16,
  12. Elisabeth Solau-Gervais17,
  13. Elisabeth Spitz4,5,6,
  14. Daniel Wendling18,19,
  15. Bruno Fautrel13,20,21,
  16. Francis Guillemin4,5,6,22 on behalf of the STPR group of the French Society of Rheumatology
  1. 1INSERM ERI 7 (EA 3822) Centre Hospitalo-Universitaire de Nantes, Hôtel-Dieu, Service de Rhumatologie, Nantes, France
  2. 2Centre hospitalier d’Aulnay sous Bois, Service de Rhumatologie, Aulnay sous Bois, France
  3. 3CHU Lapeyronie, Département de Rhumatologie, Montpellier cedex, France
  4. 4Université Henri Poincaré – Nancy 1, France
  5. 5Université Paul Verlaine Metz, Metz, France
  6. 6Université Paris Descartes, EA 4360 APEMAC, Metz, France
  7. 7Hôpital Larrey, Toulouse cedex, INSERM U558, Toulouse, France
  8. 8Univ P Sabatier, Toulouse, France
  9. 9Hôpital Sud A. Michallon Grenoble cedex, France
  10. 10Rouen University Hospital Department of Rheumatology, & Inserm U905 (IFRMP 23), University of Rouen, France
  11. 11Centre Hospitalo-Universitaire du Dijon, Hôpital du Bocage, Service de Rhumatologie, Dijon, France
  12. 12Université Denis Diderot – Paris, France
  13. 13UFR de Médecine, Paris, F-75010, France
  14. 14AP-HP, GH Bichat, Service de Rhumatologie, Paris, France
  15. 15CHU Sainte-Marguerite, Department of Rheumatology, Marseille cedex, France
  16. 16Centre Hospitalo-Universitaire de Brest, Hôpital de la Cavale Blanche, Service de Rhumatologie, Brest, France
  17. 17CHU de Poitiers, 86021 Poitiers cedex, France
  18. 18Université de Franche-Comté EA4266 - Agents pathogènes et Inflammation, and Centre, Besançon, France
  19. 19Hospitalo-Universitaire de Besançon, Hôpital Jean Minjoz, Service de Rhumatologie, Besançon, France
  20. 20Université Pierre et Marie Curie – Paris, France
  21. 21AP-HP, GH Pitié Salpêtrière, Service de Rhumatologie, Paris, France
  22. 22INSERM CIC-EC, Nancy University Hospital, Nancy, France
  1. Correspondence to Berthelot Jean-Marie, Service de Rhumatologie, Hotel-Dieu, Centre Hospitalo-Universitaire de Nantes, Nantes F-44000, France; jeanmarie.berthelot{at}


Introduction There is a lack of consensus about the definition of flare of rheumatoid arthritis (RA) and a measurement tool.

Objectives To develop a self-administered tool integrating the perspectives of the patient and the rheumatologist, enabling the detection of present or recent-past RA flare.

Methods The patient perspective was explored by semistructured individual interviews of patients with RA. Two health psychologists conducted a content analysis to extract items best describing flare from the interviews. The physician's perspective was explored through a Delphi exercise conducted among a panel of 13 rheumatologists. A comprehensive list of items produced in the first round was reduced in a four-round Delphi process to select items cited by at least 75% of the respondents. The identified elements were assembled in domains—each converted into a statement—to constitute the final self-administered Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire.

Results The content of 99 patient interviews was analysed, and 10 domains were identified: joint swelling or pain, night pain, fatigue and different emotional consequences, as well as analgesic intake. The Delphi process for physicians identified eight domains related to objective RA symptoms and drug intake, of which only four were common to domains for patients. Finally, 13 domains were retained in the FLARE questionnaire, formulated as 13 statements with a Likert-scale response modality of six answers ranging from ‘absolutely true’ to ‘completely untrue’.

Conclusion Two different methods, for patient and physician perspectives, were used to develop the FLARE self-administered questionnaire, which can identify past or present RA flare.

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  • Funding The research project was funded by an unrestricted grant from Sanofi-Aventis France. The firm had no access to the data and was not involved in the study design or conduct or data analysis.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Université Henri Poincaré – Nancy 1, Université Paul Verlaine Metz.

  • Provenance and peer review Not commissioned; externally peer reviewed.