Background/Purpose:  Patients with Rheumatoid Arthritis (RA) commonly suffer disease flares. The FLARE questionnaire was developed in order to detect the presence of a flare within the 3 months previous to the medical visit. The objective of our study was to validate the FLARE questionnaire into the Spanish language and to estimate the cut-off value for defining a disease flare.

Methods:  Patients with RA according to ACR/EULAR 2010 criteria, ≥ 18 years of age were included. Sociodemographic and disease characteristics were recorded. Patients attended a baseline visit and thereafter every 3 months. Disease activity (28 joints count, ESR, CRP, DAS28) and functional status (HAQ) were assessed at each visit. Baseline treatment was recorded and at each follow-up visit a treatment change was analysed. FLARE was translated into Spanish and cultural adapted. Patients completed the FLARE questionnaire, consisting of 13 statements that are answered on a 6/Likert scale. The final scores results of the addition of the 13 questions, with a final results range between 13 and 78; 13 representing the highest probability of having suffered a disease flare. Both patients and physicians had to answer if they considered having suffered a disease flare. Between each visit, patients completed a RAPID-3 questionnaire weekly. A disease flare was defined as an increase in DAS28 ≥ 1.2 or ≥ 0.6 if the previous DA28 was ≥3.2, a difference in RAPID-3 > 3.6 between each visit or a significant treatment change.

Results:  105 patients were included, 84.8% were women, with a median age of 44 years (IQR 34 to 54.7), median disease duration of 20.5 months (IQR 6 to 45.7 months). Patients were evaluated over 6 consecutive visits, however due to a lost to follow-up of more than 50%, only the first 3 visits were analyzed. The treatment change frequency at each visit was: N°1= 54/101 (53.5%), N°2= 31/57 (54.4%) and N°3= 16/33 (48.5%). And the types of treatment change frequency were: Steroid increase (43.8%), DMARDs increase (26.6%), DMARDs combination (8.3%), biologic therapy addition (16.3%), intraarticular steroid injection 41%. Association between mean FLARE values and changes in disease activity is shown in Table 1. In the ROC curve analysis a FLARE cut-off value of 50.5 showed a sensitivity and specificity greater than 60.

Conclusion:  The FLARE questionnaire is a valid and simple to use instrument for detecting a disease flare in RA patients. A cut-off value ≤ a 50.5 determines the presence of a disease flare within the 3 months previous to the medical visit. Table 1. Comparison between the FLARE questionnaire and other definitions of disease flare

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-the-flare-questionnaire-for-the-detection-of-a-disease-flare-in-rheumatoid-arthritis/