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Flaresare common in patients with rheumatoid arthritis (RA), but many experiencediscordant inflammation and pain flares, according to study results publishedin BMC Rheumatology.

The study included patients from the Early RA Network (ERAN) cohort (n=719). The researchers assessed patients annually up to 11 years after presentation (3703 person-years of follow-up). The researchers defined flare events in 2 different ways, which were analyzed in parallel: Disease Activity Score-28 (DAS28) or pain flares. DAS28 flares satisfied Outcome Measures in Rheumatology (OMERACT) flare criteria: increases in DAS28 since the previous assessment (1.2 points if active RA or 0.6 points if inactive RA). Pain flares were defined as a 4.8-point worsening of Short Form Health Survey 36-Bodily Pain score.

Theresearchers analyzed the first documented episode of each DAS28 and pain flarefor each patient. They then used latent class analysis to determine subgroupswith DAS28 and pain flares and compared clinical courses between subgroups.

Afteranalyzing the results, the researchers found that 45% of patients experiencedDAS28 flares and 52% experienced pain flares. Flares were usually discordant,with 60% of patients with DAS28 flare not concurrently in pain flare and 64% ofpatients with pain flare not concurrently in DAS28 flare.

Theresearchers identified 3 distinct DAS28 subgroups: the first characterized byincreases intender/swollen joint count (14.4%); the second by increases in symptoms (13.1%);and the third, which displayed lower flare severity (72.5%). They alsoidentified 2 discrete pain flare subgroups: in the first the pain flare occurredfollowing low disease activity and symptoms (88.6%) and in the second occurredon the background of ongoing active disease and pain (11.4%).

WhileDAS28 and pain flares had observed differences, both were associated withincreased disability, which persisted after the flare.

Thestudy included several limitations. The researchers noted that assessments maynot have captured data during a flares peak, while pre-flare data may notreflect the patients best clinical status. In addition, missing data may haveinfluenced the study findings.

DAS28and pain flares are discrete entities indicative of differing underlyingmechanisms, but both have immediate patient impact and lead to longer termdisability. Identifying and understanding RA flare subgroups should guidetreatment, the researchers wrote.

Disclosure: Several study authors declared affiliations with thepharmaceutical industry. Please see the original reference for a full list ofauthors disclosures.

Reference

McWilliams DF, Rahman S, James RJE, et al. Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae. [published online November 18, 2019]. BMC Rheumatol. doi:10.1186/s41927-019-0100-9

Continued here:
Manifestations of Inflammation and Pain Flares in Rheumatoid Arthritis - Rheumatology Advisor

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