ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2277

Working Harder to Stay in Control: Patient Reports of Flare in Early RA Are Associated with Higher Disease Activity and More Intensive Self Management

Susan J. Bartlett1,2, Clifton O. Bingham III3, Daming Lin4, Kathleen Andersen5, Gilles Boire6, Carol Hitchon7, Boulos Haraoui8, Edward C. Keystone9, Diane Tin10, J Carter Thorne11, Janet E. Pope12, VP Bykerk4 and CATCH Investigators and OMERACT Flare Group, 1Clinical Epidemiology, McGill University, Montreal, QC, Canada, 2Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, 3Rheumatology, Johns Hopkins University, Baltimore, MD, 4Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 5Hospital for Special Surgery, New York, NY, 6Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC, Canada, 7Department of Rheumatology, University of Manitoba, Winnipeg, MB, Canada, 8Institut de Rhumatologie, Montreal, QC, Canada, 9Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 10The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 11University of Toronto, Toronto, ON, Canada, 12University of Western Ontario, London, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , , ,

Session Information

Date: Tuesday, November 10, 2015

Title: Epidemiology and Public Health Poster (ARHP)

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
Early rheumatoid arthritis (ERA) patients attending office visits often report being
in a disease flares. We evaluated patient reports of flare in relation to
disease activity and self-management behaviors (SM) in a large Canadian ERA observational
study (CATCH).

Methods:
At each visit, patients provided ratings of flare severity (10 point VAS),
duration, symptoms, functional impacts and SM. Joint counts were obtained, and
CDAI scores were calculated. A checklist of SM strategies was developed based
on international qualitative studies by the OMERACT RA Flare Group.

Results:
The 474/1983 (24%) who reported being in flare were mostly female (76%), white
(78%) and educated (53%>high school), with a mean (SD) age of 53 (14) yrs and
symptom duration of 38 (25) months. Mean (SD) flare severity was 5.4/10 (2.4)
and 67% reported duration > 7 days; flaring patients reported significantly
more pain, fatigue, stiffness, disability, reduced participation, and
difficulty coping (table 1). SM did not differ by sex and included using analgesics
(50%) and steroids (13%); reducing (45%) and avoiding (28%) activities;
selected behaviors (massage, heat/cold, exercise); 17% called their rheumatologist
for help. Use of SM increased with flare severity for all activities except
selected behaviors and steroid use (p<.005; Table 2); trends were evident
with flare duration and use of analgesics (p=.08), avoiding activities (p=.09)
and calling the rheumatologist (p=.001). Recently diagnosed patients (0-12
months) were significantly more likely to report using SM compared to those
with RA >12 months (79% vs. 66%; p=.015) mostly using massage, heat and
exercise (40% vs 28%, p=.04). As compared to those not on biologics, more
patients on biologics reduced or avoided activities (43% vs 60%, p =.016; 25% vs
44%, p = .004). Among those with flare severity ≥ 4 and duration >7d,
80% reported SM including analgesics (57%), reducing activities (46%), behaviors
(40%), avoiding activities (34%), or calling MD (19%).

Conclusion:
Patient reports of RA flare are associated with higher disease activity; self-management
is common, and increases with flare severity and duration. SM includes limiting
participation/role activities and using additional medications and behaviors to
reduce symptoms and impacts. Self-management appears to be initiated early into
flares and highlight their substantial impact on quality of life.

 

Table 1. Symptoms and impacts of RA patients who did and did not report flares.

 

Flare

No Flare

Sig

 

N

Value

N

Value

Symptoms

 

 

 

 

 

   Pain

474

5.4 (2.5)

1496

2.1 (2.3)

.000

   Function

474

4.8 (2.8)

1509

1.8 (2.3)

.000

   Fatigue

472

4.9 (3.0)

1501

2.4 (2.7)

.000

   Stiffness

474

5.1 (2.6)

1498

2.0 (2.3)

.000

Functional Impact

 

 

 

 

 

   Physical Function

474

4.8 (2.8)

1509

1.8 (2.3)

.000

   Participation

474

4.6 (3.0)

1493

1.7 (2.3)

.000

   Coping

473

4.0 (2.7)

1497

1.5 (2.0)

.000

Swollen Joints (28)

444

2.4 (4.0)

1450

1.1 (2.7)

.000

Tender Joints (28)

451

4.0 (5.2)

1450

1.6 (3.3)

.000

CDAI

434

14.4 (11.2)

1413

5.8 (7.9)

.000

MD Global

444

2.4 (2.3)

1435

0.9 (1.6)

.000

 

Table 2. Self-management by severity and duration of flare.

N

<>Severity (0-10 NRS or VAS?)

Duration (Days)

<4/10

4-6.9/10

7-10/10

Sig

1-3 d

4-7 d

8-14 d

>14d

Sig

122 (26%)

239 (51%)

108 (23%)

80 (17%)

79 (17%)

68 (14%)

247 (52%)

Did nothing differently

41 (34%)

53 (22%)

15 (14%)

.000

23 (29%)

16 (20%)

13 (19%)

58 (23%)

.491

Reduced activities

46 (38%)

104 (48%)

61 (57%)

.005

31 (39%)

40 (51%)

34 (50%)

107 (43%)

.357

Avoided activities

17 (14%)

56 (23%)

57 (53%)

.000

14 (18%)

24 (30%)

16 (24%)

77 (31%)

.089

Massage, heat, exercise

49 (40%)

84 (35%)

46 (43%)

.750

28 (35%)

30 (38%)

21 (31%)

103 (42%)

.368

Painkillers

40 (33%)

118 (49%)

74 (69%)

.000

34 (43%)

33 (42%)

32 (47%)

136 (55%)

.083

Steroids

4 (3%)

16 (7%)

7 (7%)

.281

5 (6%)

2 (3%)

6 (9%)

14 (6%)

.431

Called rheumatologist

7 (6%)

29 (12%)

24 (22%)

.000

2 (3%)

5 (6%)

9 (13%)

46 (19%)

.001

 

Disclosure: S. J. Bartlett, PCORI, 2,NIH, 9; C. O. Bingham III, None; D. Lin, None; K. Andersen, None; G. Boire, None; C. Hitchon, The CATCH study was designed and implemented by the investigators and financially supported initially by Amgen Canada Inc. and Pfizer Canada Inc. via an unrestricted research grant since inception of CATCH. As of 2011, further support was provided by Hoff, 2; B. Haraoui, AbbVie, Amgen, BMS, Celgene, Janssen, Pfizer, Roche, UCB, 2,AbbVie, Amgen, BMS, Celgene, Janssen, Pfizer, Roche, UCB, 9,AbbVie, Amgen, BMS, Celgene, Janssen, Pfizer, Roche, UCB, 8; E. C. Keystone, Janssen Inc., 2,Abbott/AbbVie, 5,Amgen, 2,Bristol-Myers Squibb, 5,Janssen Inc., 5,Hoffmann-La Roche, Inc., 5,Janssen Inc., 2,Janssen Inc., 5,Merck Pharmaceuticals, 5,Merck Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5; D. Tin, None; J. C. Thorne, Amgen, Canada, 5; J. E. Pope, None; V. Bykerk, None.

To cite this abstract in AMA style:

Bartlett SJ, Bingham CO III, Lin D, Andersen K, Boire G, Hitchon C, Haraoui B, Keystone EC, Tin D, Thorne JC, Pope JE, Bykerk V. Working Harder to Stay in Control: Patient Reports of Flare in Early RA Are Associated with Higher Disease Activity and More Intensive Self Management [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/working-harder-to-stay-in-control-patient-reports-of-flare-in-early-ra-are-associated-with-higher-disease-activity-and-more-intensive-self-management/. Accessed .

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