Background/Purpose: Combined assessment of psoriatic arthritis (PsA) flare incidence and risk factors has not been conducted before, leading to challenges in effective flare management, especially since the concept of a PsA flare is currently undefined. Improved understanding and early identification of flares, along with personalized flare treatment, can improve patient outcomes reducing the economic and societal burden. Therefore, we systematically reviewed literature on the incidence of PsA flare, criteria used to define it, and the associated risk factors.

Methods: The databases of Embase, Medline ALL, Web of Science Core Collection and Cochrane Central Register of Controlled Trials were searched for original articles studying flare in PsA,  until September 2023. The New-Castle Ottawa scale was used to assess the quality of the included studies. The review was registered in the PROSPERO registry of systematic reviews (PROSPERO 2024: CRD42024482657).

Results: The systematic review included 54 studies of cohort, cross-sectional and clinical trial designs. Thirty-six studies assessed PsA flare incidence, risk factors or both, and 44 studies defined flare. The prevalence of current flares ranged from 7% to 50% (N=8),  and the incidence ranged from 10% to 28% for 6 months (N=4), and 22% to 23% for 12 months (N=2). Among these studies, two were of high quality and based on physician-reported flare, reporting a prevalence of current flare of 7% and an incidence of 22% and 23% over 12 months. The criteria used for defining flare could be grouped into seven categories. These categories were used alone in each study or in combination with one another, with disease activity score (e.g., DAS-28, loss of MDA) (36%), physician- and patient-reported flare (30% and 39%, respectively) being the frequently used ones. Similarly, the reviewed risk factors for PsA flare could be grouped into five categories: arthritis therapy, SARS-CoV vaccination, PsA features, pregnancy and other. Altogether, the factors showed limited or unclear evidence.

Conclusion: The prevalence of current physician-reported flare was 7% and annual incidence of physician-reported flare was 22% and 23%. Forty-four studies defined flare with changes in disease activity and physician- and patient-reported flare being commonly used. No conclusions could be drawn on risk factors for PsA flare. The findings reveal the need for a standardized definition of PsA flare, to facilitate its use in clinical and research settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psoriatic-arthritis-flare-incidence-definitions-and-risk-factors-a-systematic-review/