Pain, self-reported swollen joints tied to flares in rheumatoid arthritis

Self-reported flares are common and generally managed by analgesics in rheumatoid arthritis (RA), according to a study. In addition, they are substantiated higher activity measures, independently associated with pain and patient-reported swollen joints, and linked to treatment intensification.

The investigators examined consecutive RA patients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) <3.2 and no swollen joints at baseline, month 6, and month 12. Their assessments included joint counts, DAS28-CRP, visual analogue scale–evaluator’s global assessment (EGA), and patient-reported outcomes (PROs).

Patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire and disclosed self-management strategies every 3 months. Finally, the investigators compared flaring and nonflaring patients and explored longitudinal associations between self-reported flare status and disease activity, PRO, and treatment escalation.

Eighty patients with RA (mean age, 63 years; 74 percent females; disease duration, 11 years; baseline DAS28-CRP, 1.9) were included, of whom 64 (80 percent) reported flare at least once during 12 months. More than half (55 percent) of these flares lasted less than 1 week. Analgesics (50 percent) and restricted activities (38 percent) were the common self-management strategies. Patients with flare, compared to those without, had consistently higher disease activity measures and PRO.

Results from a partly adjusted model indicated the association of flares with patient-reported swollen and tender joint counts, disease activity measures, and all flare domains. Moreover, fully adjusted analyses revealed the independent association of present flare with pain (odds ratio [OR], 1.85, 95 percent confidence interval [CI], 1.34–2.60), patient-reported swollen joints (OR, 1.18, 95 percent CI, 1.03–1.36), and higher EGA (OR, 1.15, 95 percent CI, 1.04–1.28). Present flare also correlated with treatment escalation (p≤0.001).