RT Journal Article
SR Electronic
T1 Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, and Medication Change
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 333
OP 340
DO 10.3899/jrheum.181160
VO 47
IS 3
A1 Taysir G. Mahmoud
A1 Jie Huang
A1 Michelle Frits
A1 Christine Iannaccone
A1 Vivian Bykerk
A1 Clifton O. Bingham III
A1 Michael Weinblatt
A1 Nancy A. Shadick
YR 2020
UL http://www.jrheum.org/content/47/3/333.abstract
AB Objective. Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome.Methods. Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome.Results. Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7–2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68–7.21) and having lower flare pain (OR 0.83, 95% CI 0.71–0.97) were associated with better flare outcome.Conclusion. Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes.