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This study examined factors associated with changes in RA flares during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional COVID-19 RA study, patients with RA ICD-9\/10 codes were emailed a questionnaire in July\/November of 2020 containing questions on RA disease activity, Routine Assessment of Patient Index Data 3 (RAPID3), flare number and frequency, RA Flare Questionnaire (RA-FQ), Perceived Stress Scale 4 (PSS-4), stressors, and demographics. Age, anti-cyclic citrullinated antibody, and rheumatoid factor were extracted from medical records. Analyses examined associations between current flare status, number of flares, and changes in flare frequency with PSS-4 and stressors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1138 respondents (22.6% response rate), 69.3% reported at least one RA flare, 43% multiple flares, and 36.3% currently experiencing a flare. Compared to pre-pandemic levels, 36.3% noted more frequent flares, while 9.2% reported fewer. Increased stress was noted across all flare groups. Regression analyses revealed significant associations between current flare and PSS-4 scores, financial stress, and sleep quality (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.03). A higher number of flares were significantly associated with PSS-4, financial stress, and home stress (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.03). Increased flare frequency was associated with PSS-4, apprehension, panic, financial stress, and sleep quality (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Asian race was negatively associated with the number of flares and flare frequency (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study reports a link between stress and RA flares during the pandemic, underscoring the need for targeted strategies to manage RA patients at risk of flare during heightened stress.\n                      <jats:table-wrap>\n                        <jats:table>\n                          <jats:tbody>\n                            <jats:tr>\n                              <jats:td colspan=\"2\">\n                                <jats:bold>Key Points<\/jats:bold>\n                                \u2022\n                                <jats:italic>During the COVID-19 pandemic, patient-reported RA flares increased significantly compared to pre-pandemic levels, signifying there may be value in reevaluating RA management strategies during periods of heightened stress.<\/jats:italic>\n                                \u2022\n                                <jats:italic>Financial stress, home stress, and poor sleep were major pandemic stressors linked to current and increased frequency of RA flares.<\/jats:italic>\n                                \u2022\n                                <jats:italic>RA patients not in remission may be more susceptible to disease exacerbations while under stress, as those experiencing flares during the pandemic were less likely to have been in remission beforehand.<\/jats:italic>\n                                \u2022\n                                <jats:italic>Asian race was associated with fewer RA flares and reduced flare frequency, suggesting racial and ethnic differences may influence flare patterns.<\/jats:italic>\n                              <\/jats:td>\n                            <\/jats:tr>\n                          <\/jats:tbody>\n                        <\/jats:table>\n                      <\/jats:table-wrap>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10067-025-07754-9","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T08:44:46Z","timestamp":1769849086000},"page":"1667-1676","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rheumatoid arthritis in crisis: investigating the impact of stress on RA flares during the COVID-19 pandemic"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8547-3135","authenticated-orcid":false,"given":"Nicolette T.","family":"Morris","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6760-7451","authenticated-orcid":false,"given":"Thasia","family":"Woodworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5865-8580","authenticated-orcid":false,"given":"David A.","family":"Elashoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5705-1042","authenticated-orcid":false,"given":"Jenny","family":"Brook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-7629","authenticated-orcid":false,"given":"Daniel E.","family":"Furst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3417-9478","authenticated-orcid":false,"given":"Veena K.","family":"Ranganath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"7754_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-45213-2","author":"KF Baker","year":"2024","unstructured":"Baker KF, McDonald D, Hulme G, Hussain R, Coxhead J, Swan D et al (2024) Single-cell insights into immune dysregulation in rheumatoid arthritis flare versus drug-free remission. 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