Background/Purpose: Flare is an important, distinct feature of RA, often rendering patients immobile and contributing to a poor quality of life. Recently, there has been consensus on the domains that constitute a flare (OMERACT Flare Core Domains); however, variations in patients’ definition of a flare continue to be observed. This study seeks to evaluate how demographic and clinical characteristics contribute to these differences.

Methods: Subjects enrolled in a prospective RA registry completed a qualitative flare survey which included the open ended question “What does a flare mean to you?” Responses were categorized into the OMERACT Core Domains (pain, function, swollen/tender joints, fatigue, stiffness, patient global, participation) and research domains (emotional distress, sleep disturbance). DAS28-CRP3 was collected at the same visit. Univariate analyses evaluated demographics such as age, gender and clinical characteristics, including a disease state variable that combined the DAS and flare status (yes/no in the past 6 months) into 4 groups (low DAS/no flare, low DAS/ flare, moderate-high DAS/no flare, and moderate-high DAS/flare). Logistic regression analyses were used to model each of the above domains as the outcome with age, gender, and disease state as covariates.

Results: Among the 503 subjects, 84% were female, mean age (SD) was 61 years (13), and mean disease duration was 18 years (11.7). The mean DAS score was 2.3 (0.93). 55% reported at least 1 flare in the past 6 months. Of the 8 OMERACT Core Domains, this cohort reported on average 2.5 (1.3) domains when asked to define a flare. Pain (80%), physical function (44%), and painful joints (36%) were the most commonly recorded. 5 domains showed an association between flare definition and patient characteristics in individual logistic regression models (Table).When looking at DAS alone, we found no variations in patient reported domains to be statistically significant. Additional OR comparisons of DAS/flare status (moderate-high DAS/flare vs. moderate-high DAS/no flare) suggested high DAS influences a patient’s definition to include participation regardless of flare status.

Conclusion: Patients reported at least one of 8 OMERACT Core domains when defining a flare, however, these domains vary by patients’ demographic and clinical states. Furthermore, when a patient’s current disease activity and experience of recent flare are evaluated together, differences in patients’ descriptions of a flare are observed. Patients are more attuned to a flare as pain and fatigue when flaring in a low disease state. Considering a flare as a decrease in participation is influenced more by being in moderate-high disease activity. Variations in patients’ flare definitions can lend insight into how physicians approach patients and potentially shed light on the reasoning behind discordance between patient-clinician flare definitions.