{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:24:54Z","timestamp":1759962294902,"version":"3.37.3"},"reference-count":42,"publisher":"The Journal of Rheumatology","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2020,9,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To examine prospectively self-reported flare characteristics and their longitudinal association with disease activity and patient-reported outcomes (PRO) in patients with rheumatoid arthritis (RA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Consecutive RA patients with 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) &lt; 3.2 and no swollen joints were examined at baseline, Month 6, and Month 12. Assessments included joint counts, DAS28-CRP, visual analog scale\u2013evaluator\u2019s global assessment (EGA), and PRO. Every third month, patients completed the Flare Assessment in Rheumatoid Arthritis and RA Flare Questionnaire, and disclosed self-management strategies. Flaring and non-flaring patients were compared and longitudinal associations between self-reported flare status (yes\/no) and disease activity, PRO, and treatment escalation were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Among 80 patients with RA [74% females, mean (SD) age 63 (10) yrs, disease duration 11 (7) yrs, and baseline DAS28-CRP 1.9 (0.6)], 64 (80%) reported flare at least once during 12 months. Fifty-five percent of flares lasted less than 1 week. Common self-management strategies were analgesics (50%) and restricted activities (38%). Patients who reported being in flare had consistently higher disease activity measures and PRO compared to patients without flare. In a partly adjusted model, all flare domains, patient-reported swollen and tender joint counts and disease activity measures were associated with flares. In fully adjusted analyses, present flare was independently associated with pain (OR 1.85, 95% CI 1.34\u20132.60), patient-reported swollen joints (OR 1.18, 95% CI 1.03\u20131.36), and higher EGA (OR 1.15, 95% CI 1.04\u20131.28). Treatment escalation was associated with present flare (p \u2264 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>In RA, self-reported flares were frequent, mainly managed by analgesics, substantiated by higher disease activity measures, independently associated with pain and patient-reported swollen joints, and related to treatment escalation.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.190760","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T11:55:52Z","timestamp":1575287752000},"page":"1305-1313","source":"Crossref","is-referenced-by-count":12,"title":["Pain and Self-reported Swollen Joints Are Main Drivers of Patient-reported Flares in Rheumatoid Arthritis: Results from a 12-month Observational Study"],"prefix":"10.3899","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7360-6693","authenticated-orcid":false,"given":"Dorota","family":"Kuettel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1049-4150","authenticated-orcid":false,"given":"Jette","family":"Primdahl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-670X","authenticated-orcid":false,"given":"Ulrich","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lene","family":"Terslev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-467X","authenticated-orcid":false,"given":"Mikkel","family":"\u00d8stergaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1214-4226","authenticated-orcid":false,"given":"Randi","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas Kristian","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0858-4269","authenticated-orcid":false,"given":"S\u00f6ren","family":"M\u00f6ller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5475-7610","authenticated-orcid":false,"given":"Kim","family":"H\u00f8rslev-Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2019,12,1]]},"reference":[{"key":"2022062016350571000_47.9.1305.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210715"},{"key":"2022062016350571000_47.9.1305.2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207526"},{"key":"2022062016350571000_47.9.1305.3","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.121521"},{"key":"2022062016350571000_47.9.1305.4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/03009742.2017.1329457","article-title":"Impact of patient-reported flares on radiographic progression and functional impairment in patients with rheumatoid arthritis: a cohort study based on the AMBRA trial","volume":"47","author":"Kuettel","year":"2018","journal-title":"Scand J Rheumatol"},{"key":"2022062016350571000_47.9.1305.5","doi-asserted-by":"publisher","DOI":"10.1002\/art.11481"},{"key":"2022062016350571000_47.9.1305.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206411"},{"key":"2022062016350571000_47.9.1305.7","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.171375"},{"key":"2022062016350571000_47.9.1305.8","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0730-2"},{"key":"2022062016350571000_47.9.1305.9","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq455"},{"key":"2022062016350571000_47.9.1305.10","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket416"},{"key":"2022062016350571000_47.9.1305.11","first-page":"2250","article-title":"Incorporating the patient perspective into outcome assessment in rheumatoid arthritis-progress at OMERACT 7","volume":"32","author":"Kirwan","year":"2005","journal-title":"J Rheumatol"},{"key":"2022062016350571000_47.9.1305.12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1136\/annrheumdis-2014-eular.4457","article-title":"Frequency, severity, and duration of transient flares in rheumatoid arthritis: A survey of 403 patients","volume":"73","author":"Berthelot","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"2022062016350571000_47.9.1305.13","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090369"},{"key":"2022062016350571000_47.9.1305.14","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2015-000225"},{"key":"2022062016350571000_47.9.1305.15","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131252"},{"key":"2022062016350571000_47.9.1305.16","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110400"},{"key":"2022062016350571000_47.9.1305.17","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110401"},{"key":"2022062016350571000_47.9.1305.18","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141169"},{"key":"2022062016350571000_47.9.1305.19","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.150656"},{"key":"2022062016350571000_47.9.1305.20","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.161145"},{"key":"2022062016350571000_47.9.1305.21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/art.39850","article-title":"Validation of FLARE-RA, a self-administered tool to detect recent or current rheumatoid arthritis flare","volume":"69","author":"Fautrel","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2022062016350571000_47.9.1305.22","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200548"},{"key":"2022062016350571000_47.9.1305.23","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310302"},{"key":"2022062016350571000_47.9.1305.24","doi-asserted-by":"publisher","DOI":"10.1002\/art.27584"},{"key":"2022062016350571000_47.9.1305.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-014-2849-y"},{"key":"2022062016350571000_47.9.1305.26","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s10067-014-2848-z","article-title":"Patient-self assessment of flare in rheumatoid arthritis: translation and reliability of the flare instrument","volume":"35","author":"Maribo","year":"2016","journal-title":"Clin Rheumatol"},{"key":"2022062016350571000_47.9.1305.27","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204244corr1"},{"issue":"Suppl 10","key":"2022062016350571000_47.9.1305.28","first-page":"2277","article-title":"Working harder to stay in control: patient reports of flare in early RA are associated with higher disease activity and more intensive self management","volume":"67","author":"Bartlett","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2022062016350571000_47.9.1305.29","doi-asserted-by":"publisher","DOI":"10.1080\/03009740151095402"},{"key":"2022062016350571000_47.9.1305.30","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212256"},{"key":"2022062016350571000_47.9.1305.31","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.181160"},{"key":"2022062016350571000_47.9.1305.32","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/s13075-017-1428-4","article-title":"Ultrasound of the hand is sufficient to detect subclinical inflammation in rheumatoid arthritis remission: a post hoc longitudinal study","volume":"19","author":"Hammer","year":"2017","journal-title":"Arthritis Res Ther"},{"key":"2022062016350571000_47.9.1305.33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/rheumatology\/kez231","article-title":"Flares in rheumatoid arthritis: do patient-reported swollen and tender joints match clinical and ultrasonography findings?","volume":"59","author":"Kuettel","year":"2020","journal-title":"Rheumatology"},{"key":"2022062016350571000_47.9.1305.34","first-page":"A236","article-title":"Optimization of flare management in patients with rheumatoid arthritis: results of a randomised controlled trial","volume":"78","author":"Myasoedova","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"2022062016350571000_47.9.1305.35","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1002\/acr.22902","article-title":"Patient-physician discordance in global assessment in rheumatoid arthritis: a systematic literature review with meta-analysis","volume":"68","author":"Desthieux","year":"2016","journal-title":"Arthritis Care Res"},{"key":"2022062016350571000_47.9.1305.36","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/acr.23815","article-title":"Tender joint count may not reflect inflammatory activity in established rheumatoid arthritis patients - results from a longitudinal study","volume":"72","author":"Hammer","year":"2020","journal-title":"Arthritis Care Res"},{"key":"2022062016350571000_47.9.1305.37","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213217"},{"key":"2022062016350571000_47.9.1305.38","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2011.2"},{"key":"2022062016350571000_47.9.1305.39","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B3.20167"},{"key":"2022062016350571000_47.9.1305.40","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131217"},{"key":"2022062016350571000_47.9.1305.41","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205428"},{"key":"2022062016350571000_47.9.1305.42","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.semarthrit.2019.09.004","article-title":"Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire","volume":"50","author":"Myasoedova","year":"2020","journal-title":"Semin Arthritis Rheum"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.190760","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T23:37:11Z","timestamp":1655768231000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.190760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,1]]},"references-count":42,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,1]]},"published-print":{"date-parts":[[2020,9,1]]}},"alternative-id":["10.3899\/jrheum.190760"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.190760","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"type":"print","value":"0315-162X"},{"type":"electronic","value":"1499-2752"}],"subject":[],"published":{"date-parts":[[2019,12,1]]}}}