title: Self-management strategies used during flares of rheumatoid arthritis in an ethnically diverse population.
abstract: OBJECTIVE
  Effective management of flares of rheumatoid arthritis (RA) can improve symptoms and may delay disease progression. The practice of rheumatologists in managing a flare has been studied, but patients' experiences of, and responses to, disease flares remain poorly defined. This study aimed to address this issue.
  
  
  METHODS
  Semi-structured interviews were conducted with 21 patients from an ethnically diverse population who had suffered a recent RA flare. Open questions were asked regarding patients' definitions of a flare, causal attribution, self-management strategies, their triggers to consult health professionals, and the information they had received about RA flares from health professionals. Transcripts were studied using the grounded theory approach to identify themes.
  
  
  RESULTS
  Flares were usually described as worsening joint pain and swelling. Over-use of joints was identified as the most common cause of a flare, and commonly used self-management strategies included rest, gentle exercise and warming the joints. There was some variation in causal attribution and self-management with ethnicity.
  
  
  CONCLUSIONS
  This study identified a link between causal attribution of flares and the resultant self-management strategies. A perceived trigger of the flare in some patients formed a focus for their self-management strategies, whereas those who could not identify a cause aimed mainly to alleviate symptoms. A better understanding of patients' perspective in the context of disease flares will allow the development of educational programmes to facilitate more effective self-management of this important manifestation of disease.
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kett
authors.forename: Julia
authors.initials: J
authors.lastname: Flint
authors.forename: Mark
authors.initials: M
authors.lastname: Openshaw
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.forename: Kanta
authors.initials: K
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy*; D003625:Data Collection; D018450:Disease Progression; D005006:Ethnicity; D015444:Exercise; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D012146:Rest; D012648:Self Care / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult