Session Type: Abstract Submissions (ACR)
Flare is an important aspect of rheumatoid arthritis (RA) patients’ disease experience with a crucial impact on quality of life and well-being. The flare-assessment in RA (FLARE) questionnaire was developed for the detection of flares based on the joint symptoms and systemic impact of RA disease over the most recent 3 months. We aimed to assess the performance of FLARE questionnaire in relation to clinical and laboratory measures of RA disease activity/severity in RA patients.
Patients with RA (age≥18 yrs; 1987 ACR criteria) participating in an ongoing population-based cohort study completed FLARE, Bristol Rheumatoid Arthritis Fatigue (BRAF) questionnaires and Health Assessment Questionnaire (HAQ) with visual analogue scale for pain (VAS pain) on 100mm scale during a study visit (2012-2014), and submitted a blood sample for C-reactive protein (CRP) and Interleukin-6 (IL6) assessment. Retrospective medical records review was performed to collect prior history of flares (as per OMERACT 9 definition), as well as physician clinical assessment (PCA) and patient global assessment (PGA) of RA disease activity on 100mm scale for the most recent clinical visit prior to the study visit. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-based Index of RA Severity (CIRAS) were used to estimate RA severity based on the recent year of data on RA disease characteristics and medications. Pearson’s correlation was used to examine relationships between the variables.
: The study included 160 RA patients (mean age 62.6 years; 74% female; mean RA duration 14.7 yrs). The mean standard deviation (SD) of the overall FLARE score was 2.47 (2.54) on 0-10 scale; 1.82 (2.43) for systemic subscale; 3.26 (3.08) for joint subscale. Mean (SD) CRP was 4.15 (5.8) mg/L; IL6 3.48 (5.52) pg/ml; HAQ 0.64 (0.62); VAS pain 28.6 (24.6). FLARE score overall and both subscales were statistically significantly correlated with BRAF, HAQ, VAS pain, IL6 and PGA, but not PCA (Table). CRP was significantly correlated with overall FLARE score and systemic, but not joint subscale. There was a statistically significant correlation of FLARE overall and its joint subscale with RARBIS, but not CIRAS. No significant correlation of FLARE was found with any history of prior flare. In a subset of patients (n=28) who had a clinical visit within 3 months of the study visit, being in a flare at that visit correlated with FLARE overall (r=0.41, p=0.03) and joint subscale (p=0.51, p=0.006), but not systemic subscale (r=0.26, p=0.18).
Conclusion The FLARE score is highly correlated with other measures of RA patients’ self-report, i.e. BRAF, HAQ, VAS pain and PGA; with systemic inflammatory markers, RARBIS and flare at the most recent visit. Our findings suggest that FLARE questionnaire may be a reliable tool for RA flare detection reflecting clinical and laboratory aspects of RA disease activity.
C. S. Crowson,
E. L. Matteson,
S. E. Gabriel,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identifying-flare-in-rheumatoid-arthritis-ra-performance-of-the-flare-assessment-in-ra-flare-questionnaire-in-a-us-population/