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Patients with Either Rheumatoid Arthritis (RA) or Axial Spondyloarthritis (axSpA) [...]

Jacquemin, C., Servy, H., Molto, A., Sellam, J., Foltz, V., Gandjbakhch, F., Hudry, C., Mitrovic, S., Fautrel, B., Gossec, L. (September 2016)

Background/Purpose: The evolution of RA and axSpA is characterized by alternated periods of flares and remission. This fluctuating disease activity can be self-assessed by a single question [1]. The objective was to assess the frequency of flares when assessed weekly and the link between flares and well-validated patient reported outcomes (PROs).

Methods: In this prospective longitudinal multicenter observational study aiming to explore physical activity and its relation with disease activity. Patients had definite axSpA (ASAS criteria) or RA (ACR/EULAR criteria). Patients were asked to complete every week during 3 months different PROs including pain and patient global assessment (PGA) and flare status. Flares were recorded using the question (« has your disease flared up during the last 7 days ? ») [1], with a categorical response: no flare, flare lasting 1 to 3 days or flare lasting more than 3 days. Flare frequency was calculated by the number of reported flares divided by the number of completed questionnaires over the 3 months. The frequency of flares in RA and axSpA patients was compared by Mann-Whitney test. Pain and PGA were compared across assessments according to flare status using ANOVA on repeated measures (linear mixed-effects model).

Results: 86 patients (45 RA and 41 axSpA patients) were included in this analysis: 37 (43.0%) were males, with a mean age of 46.3 (±11.7) and a mean disease duration of 10.8 (±7.9) years, 48 (55.8%) were receiving a biologic. RA and axSpA patients had respectively a mean DAS 28 of 2.2 (±1.0) and a mean BASDAI of 3.5 (±2.1). Patients reported flares on average in 23.9% (±23.1) of the weekly questionnaires, with a mean frequency of ‘1 to 3 days flares’ and ‘>3 days flares’ respectively of 17.2% (±17.0) and 6.7% (±14.1). Flare frequency and duration of flares were higher in RA than axSpA, in particular for short flares, though this difference did not reach statistical significance. Pain and PGA were higher when patients self-reported flares and in particular longer flares rather than “bad days”.

Conclusion: self-reported flares were frequent in RA and axSpA, in this population of long-standing disease with good inflammation control. Long flares (>3 days) were less frequent. Self-reported flares were substantiated by higher PROs. More work is needed on long-term effects of flares.


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