title: A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: the 'FLARE' instrument.
abstract: BACKGROUND
  There is a lack of consensus about the definition of flare of rheumatoid arthritis (RA) and a measurement tool.
  
  
  OBJECTIVE
  To develop a self-administered tool integrating the perspectives of the patient and the rheumatologist, enabling the detection of present or recent-past RA flare.
  
  
  METHODS
  The patient perspective was explored by semistructured individual interviews of patients with RA. Two health psychologists conducted a content analysis to extract items best describing flare from the interviews. The physician's perspective was explored through a Delphi exercise conducted among a panel of 13 rheumatologists. A comprehensive list of items produced in the first round was reduced in a four-round Delphi process to select items cited by at least 75% of the respondents. The identified elements were assembled in domains-each converted into a statement-to constitute the final self-administered Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire.
  
  
  RESULTS
  The content of 99 patient interviews was analysed, and 10 domains were identified: joint swelling or pain, night pain, fatigue and different emotional consequences, as well as analgesic intake. The Delphi process for physicians identified eight domains related to objective RA symptoms and drug intake, of which only four were common to domains for patients. Finally, 13 domains were retained in the FLARE questionnaire, formulated as 13 statements with a Likert-scale response modality of six answers ranging from 'absolutely true' to 'completely untrue'.
  
  
  CONCLUSIONS
  Two different methods, for patient and physician perspectives, were used to develop the FLARE self-administered questionnaire, which can identify past or present RA flare.
authors.affiliation: INSERM ERI 7 (EA 3822) Centre Hospitalo-Universitaire de Nantes, Hôtel-Dieu, Service de Rhumatologie, Nantes, France. jeanmarie.berthelot@chu-nantes.fr
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
authors.forename: Michel
authors.initials: M
authors.lastname: De Bandt
authors.forename: Jacques
authors.initials: J
authors.lastname: Morel
authors.forename: Fatima
authors.initials: F
authors.lastname: Benatig
authors.forename: Arnaud
authors.initials: A
authors.lastname: Constantin
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loet
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Olivier
authors.initials: O
authors.lastname: Meyer
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Solau-Gervais
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Spitz
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003697:Delphi Technique; D059026:Diagnostic Self Evaluation; D018450:Disease Progression; D006801:Humans; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D010819:Physician's Role; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents