TY - JOUR
T1 - Correlates of successful rheumatoid arthritis flare management
T2 - Clinician-driven Treatment, Home-based Strategies, and Medication Change
AU - Mahmoud, T. G.
AU - Huang, J.
AU - Frits, M.
AU - Iannaccone, C.
AU - Bykerk, V.
AU - Bingham, C. O.
AU - Weinblatt, M.
AU - Shadick, N. A.
N1 - Funding Information:
From the Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Research reported in this publication was supported by Mallinckrodt Pharmaceuticals. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. Additionally, the BRASS registry is funded by Amgen, Bristol-Myers Squibb, Crescendo Bioscience, Regeneron, and Sanofi.
Publisher Copyright:
Copyright © 2020 The Journal of Rheumatology . All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Objective. Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome. Methods. Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome. Results. Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7-2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68-7.21) and having lower flare pain (OR 0.83, 95% CI 0.71-0.97) were associated with better flare outcome. Conclusion. Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes.
AB - Objective. Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome. Methods. Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome. Results. Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7-2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68-7.21) and having lower flare pain (OR 0.83, 95% CI 0.71-0.97) were associated with better flare outcome. Conclusion. Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes.
KW - Disease-modifying antirheumatic drugs
KW - Pain
KW - Rheumatoid arthritis
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U2 - 10.3899/jrheum.181160
DO - 10.3899/jrheum.181160
M3 - Article
C2 - 31203222
AN - SCOPUS:85081072182
SN - 0315-162X
VL - 47
SP - 333
EP - 340
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 3
ER -