title: Frequency and characteristics of disease flares in ankylosing spondylitis.
abstract: OBJECTIVE
  To examine the characteristics and frequency of disease flares in a cohort of people with AS.
  
  
  METHODS
  A prospective data set from a randomized controlled trial (RCT) of a probiotic treatment/placebo was utilized to examine disease flares in 134 people with AS. Disease flares were defined as either minor/localized flares (pain/swelling localized to one area with fatigue and stiffness) or major/generalized flares (generalized pain, hot burning joints, muscle spasm, fever, sweating, extreme fatigue and stiffness). Results. One hundred and thirty-four people were followed up for 1216 person follow-up weeks and there were 71.4 flares per 100 person-weeks. Of these, 12 were major/generalized flares and 59.4 were minor/localized flares. People who experienced at least one major/generalized flare during the study period had worse disease during flare-free periods in terms of disease activity, impaired function, self-reported night pain and iritis compared with those who did not experience any major/generalized flares during the study. Major/generalized flares lasted for an average of 2.4 weeks (s.d. 2.7), and were preceded by and followed by a minor/localized flare in 92% (55/60) of cases.
  
  
  CONCLUSIONS
  Seventy per cent of people with AS felt they had a flare in any given week. Those who experienced major/generalized flares appear to have more severe and active disease even during periods when not in flare, compared with those who do not experience major/generalized flares. These results have implications for the timing of assessments prior to starting anti-TNF therapy and suggest that the presence of major flares may be helpful in identifying patients with severe disease.
authors.affiliation: School of Medicine, Swansea University, Swansea, UK.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Cooksey
authors.forename: Sinead
authors.initials: S
authors.lastname: Brophy
authors.forename: Mike B
authors.initials: MB
authors.lastname: Gravenor
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Brooks
authors.forename: Claire L
authors.initials: CL
authors.lastname: Burrows
authors.forename: Stefan
authors.initials: S
authors.lastname: Siebert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000503:physiopathology*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha