{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:39:19Z","timestamp":1792481959223,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005006","name":"Asan Institute for Life Sciences, Asan Medical Center","doi-asserted-by":"publisher","award":["2024IP0030\u20101"],"award-info":[{"award-number":["2024IP0030\u20101"]}],"id":[{"id":"10.13039\/501100005006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the frequency and management of flares in rheumatoid arthritis (RA) patients treated with biologic or targeted synthetic disease\u2010modifying antirheumatic drugs (b\/tsDMARDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were analyzed from the KOrean nationwide BIOlogics (KOBIO) registry, which includes RA patients initiating b\/tsDMARDs therapy. Flares were defined as an increase in DAS28 (&gt;\u20091.2, or &gt;\u20090.6 if DAS28\u2009\u2265\u20093.2) requiring medication changes. Patients were stratified by flare occurrence, and predictive factors and management strategies were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 2745 RA patients, 386 (14.1%) experienced flares over a median follow\u2010up period of 5.4\u2009years (IQR, 1.7\u201311.4). Flares were associated with a significantly higher incidence of shoulder swelling compared with non\u2010flare patients (14.2% vs. 13.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Predictive factors for flares included a higher swollen joint count (HR: 1.125,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and shoulder swelling (HR: 2.810,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Eight patients switched to an alternative b\/tsDMARD during flare episodes, while 168 added or modified conventional synthetic DMARDs (csDMARDs). The remaining 210 patients made no changes to their csDMARD regimen. The 12\u2009month retention rate of b\/tsDMARDs did not significantly differ between patients who adjusted their csDMARDs and those who did not (86.7% vs. 82.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.23). However, the mean steroid dose over 12\u2009months was lower in the group that adjusted csDMARDs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Flares occurred in approximately 14% of RA patients during b\/tsDMARD treatment, with baseline joint involvement, particularly shoulder swelling, being a predictor. While the adjustment of csDMARDs was associated with reduced steroid use during flare management, it did not significantly affect b\/tsDMARD retention rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.70631","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:21:26Z","timestamp":1774848086000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Characteristics and Management for Flares in Patients With Rheumatoid Arthritis Treated With Biologic and Targeted Synthetic Disease\u2010Modifying Antirheumatic Drugs"],"prefix":"10.1111","volume":"29","author":[{"given":"Young\u2010Eun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Min","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Seon","family":"Oh","sequence":"additional","affiliation":[{"name":"Information Medicine, Big Data Research Center, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong\u2010Gil","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang\u2010Keun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-3124","authenticated-orcid":false,"given":"Seokchan","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Asan Medical Center University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature01661"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keab609"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.4078\/jrd.2020.27.1.4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.171375"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.121521"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141520"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0730-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.181160"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-019-04664-5"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.4078\/jrd.2021.28.4.176"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27584"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.091454"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203496"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40064-015-0895-9"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.7.638"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0216624"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-48537-z"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27227"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-021-04989-y"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-022-05237-7"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-023-05458-4"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-024-05752-9"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39626"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.066704"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.121248"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-06933-4"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216656"},{"issue":"3","key":"e_1_2_11_29_1","first-page":"523","article-title":"Rate 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