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

Bykerk, Vivian P.; Shadick, Nancy; Frits, Michelle; Bingham, Clifton O.; Jeffery, Iain; Iannaccone, Christine; Weinblatt, Michael E.; Solomon, Daniel H.

doi:10.3899/jrheum.121521

Cited by 56 publications

(52 citation statements)

References 19 publications

(35 reference statements)

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“…We utilized data from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS; Clinical-Trials.gov identifier NCT01793103), which was initiated in 2003-2004. Details concerning the study design have been reported elsewhere ( [30][31][32]; for further details, see http:// www.brassstudy.org.). The BRASS Registry is a single-center, prospective, observational longitudinal cohort of .1,200 adults with established or recent-onset RA who are being followed by a hospital-based practice of 21 rheumatologists in Boston.…”

Section: Methodsmentioning

confidence: 99%

Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data

Alemao

Joo

Kawabata

et al. 2016

Arthritis Care & Research

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ObjectiveTo evaluate associations between achieving guideline‐recommended targets of disease activity, defined by the Disease Activity Score in 28 joints using C‐reactive protein level (DAS28‐CRP) <2.6, the Simplified Disease Activity Index (SDAI) ≤3.3, or the Clinical Disease Activity Index (CDAI) ≤2.8, and other health outcomes in a longitudinal observational study.MethodsOther defined thresholds included low disease activity (LDA), moderate (MDA), or severe disease activity (SDA). To control for intraclass correlation and estimate effects of independent variables on outcomes of the modified Health Assessment Questionnaire (M‐HAQ), the EuroQol 5‐domain (EQ‐5D; a quality‐of‐life measure), hospitalization, and durable medical equipment (DME) use, we employed mixed models for continuous outcomes and generalized estimating equations for binary outcomes.ResultsAmong 1,297 subjects, achievement (versus nonachievement) of recommended disease targets was associated with enhanced physical functioning and lower health resource utilization. After controlling for baseline covariates, achievement of disease targets (versus LDA) was associated with significantly enhanced physical functioning based on SDAI ≤3.3 (ΔM‐HAQ −0.047; P = 0.0100) and CDAI ≤2.8 (−0.073; P = 0.0003) but not DAS28‐CRP <2.6 (−0.022; P = 0.1735). Target attainment was associated with significantly improved EQ‐5D (0.022–0.096; P < 0.0030 versus LDA, MDA, or SDA). Patients achieving guideline‐recommended disease targets were 36–45% less likely to be hospitalized (P < 0.0500) and 23–45% less likely to utilize DME (P < 0.0100).ConclusionAttaining recommended target disease‐activity measures was associated with enhanced physical functioning and health‐related quality of life. Some health outcomes were similar in subjects attaining guideline targets versus LDA. Achieving LDA is a worthy clinical objective in some patients.

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Section: Methodsmentioning

confidence: 99%

Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data

Alemao

Joo

Kawabata

et al. 2016

Arthritis Care & Research

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“…The term “flare” is often used to describe episodes of disease worsening in RA, which are often unexplained and debilitating 4 . Flares can vary widely in frequency, duration, and intensity 5 , and until recently, there has been little consensus on how to identify or define RA flares. For example, patients may use the word “flare” to describe any increase (transient or sustained) in RA symptoms such as joint pain, stiffness, or fatigue 6 .…”

Section: Flare In Rheumatoid Arthritismentioning

confidence: 99%

Establishing a Core Domain Set to Measure Rheumatoid Arthritis Flares: Report of the OMERACT 11 RA Flare Workshop

Bykerk

Lie²,

Bartlett³

et al. 2014

J Rheumatol

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Objective The OMERACT Rheumatoid Arthritis (RA) Flare Group (FG) is developing a data-driven, patient-inclusive, consensus-based RA flare definition for use in clinical trials, longterm observational studies, and clinical practice. At OMERACT 11, we sought endorsement of a proposed core domain set to measure RA flare. Methods Patient and healthcare professional (HCP) qualitative studies, focus groups, and literature review, followed by patient and HCP Delphi exercises including combined Delphi consensus at Outcome Measures in Rheumatology 10 (OMERACT 10), identified potential domains to measure flare. At OMERACT 11, breakout groups discussed key domains and instruments to measure them, and proposed a research agenda. Patients were active research partners in all focus groups and domain identification activities. Processes for domain selection and patient partner involvement were case studies for OMERACT Filter 2.0 methodology. Results A pre-meeting combined Delphi exercise for defining flare identified 9 domains as important (> 70% consensus from patients or HCP). Four new patient-reported domains beyond those included in the RA disease activity core set were proposed for inclusion (fatigue, participation, stiffness, and self-management). The RA FG developed preliminary flare questions (PFQ) to measure domains. In combined plenary voting sessions, OMERACT 11 attendees endorsed the proposed RA core set to measure flare with ≥ 78% consensus and the addition of 3 additional domains to the research agenda for OMERACT 12. Conclusion At OMERACT 11, a core domain set to measure RA flare was ratified and endorsed by attendees. Domain validation aligning with Filter 2.0 is ongoing in new randomized controlled clinical trials and longitudinal observational studies using existing and new instruments including a set of PFQ.

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“…Furthermore, studies have demonstrated that improvements in these disease‐specific outcomes are associated with reduced pain and improved physical function, health‐related quality of life, and work productivity , suggesting that minimizing the amount of time RA patients spend with MHDAS is beneficial. Even brief periods of MHDAS (<3 months) are associated with progression of joint damage and worsened short‐term and long‐term pain and functional deterioration . Addressing delays in therapy adjustment is important for RA patients with MHDAS, which may increase the negative impact of the disease on current and future symptoms and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Timing and Impact of Decisions to Adjust Disease‐Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease

Shaw

Chang

Levesque

et al. 2018

Arthritis Care & Research

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

Cited by 56 publications

References 19 publications

Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data

Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data

Establishing a Core Domain Set to Measure Rheumatoid Arthritis Flares: Report of the OMERACT 11 RA Flare Workshop

Timing and Impact of Decisions to Adjust Disease‐Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease

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