RT Journal Article
SR Electronic
T1 Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, & Medication Change
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.181160
DO 10.3899/jrheum.181160
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 2019
UL http://www.jrheum.org/content/early/2019/06/11/jrheum.181160.abstract
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.