Session Information
Session Type: Abstract Submissions (ARHP)
Background/Purpose: Previous research has not addressed how RA patients’ symptoms change daily. The aim of this study was to explore symptom patterns during daily life and flare.
Methods: RA patients completed self-reported NRS (0-10) of pain, fatigue, swollen joints, stiffness, anger, frustration, worry and flare status (yes/no) daily for 3 months either on paper or online. This was an exploratory study and therefore not powered for statistical significance. Data were analysed for descriptive statistics and visually analysed with the use of graphs to identify symptom patterns.
Results: 28 patients took part: 5 withdrew, 6 had missing data for >10/91 days. The 17 patients included in the analysis were 15 female, mean age: 62.9yrs, disease duration: 18.6yrs, HAQ: 1.86
On plotting the symptoms onto graphs, 3 patients reported constant flare for 91 days (constant flare group), 6 patients self-reported ≥1 flare with periods of non-flare (intermittent flare group) and 8 patients did not report being in a flare (daily life group).
As expected, the group means of the individual symptoms were highest in the constant flare group and lowest in the daily life group. In the daily life group, patients’ individual mean pain scores ranged from 0.2 to 5.8, whereas in the intermittent flare group patients’ individual mean pain scores ranged from 2.5 to 7.0 and in the constant flare group patients’ individual mean pain scores ranged from 2.4 to 9.3. Thus some individual patients reported lower mean pain in flare than other patients reported on non-flare days, this was also the case with the other self-reported measures (see Table 1).
Further 5/6 patients in the intermittent flare group rated their symptoms as more severe on non-flare days than on days in flare. Thus patients may be using different criteria other than symptoms to decide whether they are in a flare.
Whilst many patients report traditional ‘Inflammatory Flare’ of symptoms, other patients may be reporting flare based on experiencing overall loss of control in their lives and thus defining their overall disease activity as more severe (in flare) despite individual symptoms being less severe. The term ‘Avalanche Flare’ is proposed for this cascading effect of life.
Conclusion: Definitions of flare vary within and between patients and may not be defined by symptom severity alone. Clinicians need to be aware that patients use ‘flare’ to explain a range of experiences. Understanding the terminology is necessary to improve communication and inform treatment decisions.
Table 1: Mean symptom scores for the three different trajectories
|
|
|
Pain |
Fatigue |
Stiffness |
Swollen Joints |
Frustration |
Anger |
Worry |
|
Constant |
Group Mean (SD) |
4.3 (2.7) |
4.7 (2.7) |
3.6 (2.6) |
3.9 (2.6) |
3.7 (2.9) |
3.1 (3.3) |
3.7 (3.1) |
|
Lowest Individual Patient Mean |
2.4 (1.3) |
4.4 (2.1) |
2.3 (1.5 |
2.2 (1.4) |
1.1 (1.3) |
0.7 (0.9) |
0.6 (0.9) |
|
|
Highest Individual Patient Mean |
9.3 (0.8) |
9.3 (0.7) |
9.5 (0.8) |
9.5 (0.7) |
9.0 (0.7) |
8.9 (0.7) |
8.9 (0.7) |
|
|
Intermittent |
Group Mean |
4.8 (2.3) |
4.9 (2.0) |
4.0 (2.1) |
4.4 (2.1) |
4.1 (2.2) |
3.1 (2.6) |
4.3 (2.4) |
|
Lowest Individual Patient Mean |
2.5 (1.2) |
2.7 (1.2) |
1.7 (0.7) |
2.3 (0.8) |
2.1 (0.7) |
0.0 (0.1) |
1.9 (0.8) |
|
|
Highest Individual Patient Mean |
7.0 (0.6) |
7.4 (1.0) |
6.2 (1.1) |
6.5 (0.9) |
6.3 (1.2) |
5.7 (1.3) |
7.8 (1.2) |
|
|
Daily |
Group Mean |
3.1 (2.3) |
3.6 (2.6) |
2.4 (1.5) |
2.7 (1.9) |
2.8 (2.9) |
2.2 (3.3) |
2.7 (3.1) |
|
Lowest Individual Patient Mean |
0.2 (0.5) |
0.4 (0.9) |
0.3 (0.7) |
0.5 (0.9) |
0.0 (0.0) |
0.0 (0.0) |
0.0 (0.0) |
|
|
Highest Individual Patient Mean |
5.8 (2.2) |
7.6 (2.0) |
4.8 (1.6) |
6.5 (1.6) |
8.7 (0.7) |
9.2 (0.7) |
9.4 (0.6) |
Disclosure:
C. A. Flurey,
Arthritis Research UK,
2;
M. Morris,
None;
J. Pollock,
None;
R. A. Hughes,
None;
P. Richards,
None;
S. Hewlett,
Arthritis Research UK,
2.
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