PT  - JOURNAL ARTICLE
AU  - Taysir G  Mahmoud
AU  - Jie Huang
AU  - Michelle Frits
AU  - Christine Iannaccone
AU  - Vivian Bykerk
AU  - Clifton O.  Bingham  III
AU  - Michael Weinblatt
AU  - Nancy A  Shadick
TI  - Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, & Medication Change
AID  - 10.3899/jrheum.181160
DP  - 2019 Jun 15
TA  - The Journal of Rheumatology
PG  - jrheum.181160
4099  - http://www.jrheum.org/content/early/2019/06/11/jrheum.181160.short
4100  - http://www.jrheum.org/content/early/2019/06/11/jrheum.181160.full
AB  - Objective Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful post flare outcome. Methods Data were collected from the BRASS registry, including clinical and patient reported outcomes, and a survey with a Likert scale assessing post flare 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. Clinical trial registration: NCT01793103. Results Of 503 participants, 185 reported at least one flare that had resolved in the past 6 months, median (IQR) DAS28-CRP3 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 (1.68, 7.21)] and having lower flare pain [OR 0.83 (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 directions might address how best to intervene when patients experience flares and whether patient initiated medication changes have adverse outcomes.