Flares in Rheumatoid Arthritis: Frequency and Management. A Report from the BRASS Registry

Objective. To describe the frequency, duration, and management of flares as reported by patients with rheumatoid arthritis (RA). Methods. Data were collected in a prospective observational study of patients with RA recruited from a single academic center and treated according to the rheumatologists' discretion. Every 6 months, patients reported the number and duration of RA flares and described how these were managed in terms of adding or changing medication and use of nonpharmacologic strategies. Results. Of patients who reported flares at least once during the study, 74% reported having flares 6 months prior to study entry and 59% reported flares prior to the first 6-month visit. At subsequent visits, 54-57% reported having > 1 flare. Thirty percent of patients in remission reported flares. Flare duration lasted >= 2 weeks in 30%, 1-2 weeks in 13%, and < 1 week in 57%. Forty percent reported medication changes at the time of their flare; 16% changed medication and used nonpharmacologic strategies and 26% of patients reported no changes in treatment as a result of flares. Longer duration of flare was associated with changes in disease-modifying therapy. Conclusion. Patients with RA experienced flares more often when noted to be,in higher disease activity states than when in remission and reported changes in disease-modifying antirheumatic drugs or biologics more frequently when flares were of longer duration. There is a need to prospectively study symptom intensity and duration of flare in relation to disease activity and consider self-management strategies in the development of a measure of flare.