Major flares as a diagnostic and prognostic measure when assessing ankylosing spondylitis severity

Abstract

Impact of flares: a patient’s perspective Flares are an important aspect of living with a chronic inflammatory condition, and the study of flares was identified as a topic worthy of fur ther research in a recent Arthritis Research UK Spondyloarthropathy (SpA) Research Strategy meeting. From a patient’s perspective, flares are important because of their unpredictability. When disease is stable, a person can plan life around it; an unpredictable flare will always seem to come at the wrong time. A person might have had the disease under control for some time, perhaps following a new treatment, with all the positive benefits that brings. If the initial signs of a flare appear, they are immediately followed by a sense of dread of what might be to come. They can engender a sense of failure. Flares can hinder social interactions, because the expectations of others may often be built based on the stable condition, with little knowledge or understanding of how this can rapidly change. The effects of both major and minor flare are an important aspect of living with ankylosing spondylitis (AS). There can be a very subtle and unstable balance in a person’s ability to cope with a chronic condition. A person may be able to accept and manage a chronic condition based on modifying lifestyle and with successful medicine. Yet sometimes even a minor deviation from the expected can be very difficult to adjust to and have profound effects. What we know about flares: evidence to date In focus groups, patients with ankylosing s pondylitis (AS) have defined flares [1] as either: ƒ ƒ A localized worsening of disease, typically pain and immobility in one area accompanied by fatigue (minor flare);