Abstract
BackgroundDisease flares are common in rheumatoid arthritis (RA) and are related to structural damage. However, few data on the impact of flares reported by patients on radiographic progression are available. Our aim was to investigate whether overall flares (OF), self-reported flares (SRF) and short flares assessed at the visit (SF) predict radiographic progression in RA patients in DAS28 (28-joint disease activity score) remission.MethodsWe reviewed the records of RA patients included in our database. We considered all patients who had a period of at least 24 months in remission (DAS28 < 2.6), stable biologic and synthetic disease-modifying anti-rheumatic drug treatment, no missing follow-up visits and hands and feet radiographs at the start and at the end of the 24-month follow up. Radiographic progression was considered as an increase in the van der Heijde modified total Sharp score >0. Patients were assessed every 3 months and flares were recorded. We defined SRF as any worsening of the disease reported by patients occurring in the time between visits and SF as an increase in DAS28 ≥ 2.6 or >0.6 from the previous visit assessed by the physician in one isolated visit. The impact of SRF, SF and OF on radiographic progression was assessed through multivariate regression analysis.ResultsOne hundred forty-nine patients were included. The median number (interquartile range) of OF was 1.00/year (0.50; 1.38), of SRF was 0.50/year (0.14; 1.00), and of SF was 0.34/year (0; 0.50). Eighteen patients (12.1 %) experienced a progression of radiographic damage. OF and SRF were significant predictors of radiographic progression: OR 3.27, 95 % CI 1.30, 8.22 and OR 3.63, 95 % CI 1.16, 11.36, respectively.ConclusionsOF and SRF are predictors of structural damage. Flares assessed at the visit, SF, do not impact on radiographic progression as they might underestimate the actual number of flares.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-0986-1) contains supplementary material, which is available to authorized users.
Highlights
Disease flares are common in rheumatoid arthritis (RA) and are related to structural damage
The aim of our study was to investigate whether flares predict radiographic evidence of progression in RA patients in 28-joint disease activity score (DAS28) remission, examining flares reported by patients, self-reported flares (SRF), and short flares (SF) defined according to the DAS28 at the time of the visit
This study provides further evidence that flares are common in RA patients even those in DAS28 remission [2]: considering SF and SRF together, patients had a median of 1 flare per year and SRF were almost two-fold more frequent than SF
Summary
Disease flares are common in rheumatoid arthritis (RA) and are related to structural damage. Few data on the impact of flares reported by patients on radiographic progression are available. Our aim was to investigate whether overall flares (OF), self-reported flares (SRF) and short flares assessed at the visit (SF) predict radiographic progression in RA patients in DAS28 (28-joint disease activity score) remission. The Outcome Measures in Rheumatology Clinical Trials group has recently proposed a core domain set to measure RA flare [3], and the French Strategy of Treatment in Patients with Rheumatoid Arthritis Group has developed a patient self-assessed questionnaire, FLARE, to identify fluctuations of disease activity that occur in the time between visits [4]. Temporary variations in disease activity have already been related to radiographic evidence of progression [5,6,7] and disease flares at the time of the visit are proved to be associated with disability [6, 7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
