title: Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus.
abstract: OBJECTIVE
  For rheumatoid arthritis (RA), there is no consensus on how to define and assess flare. Variability in flare definitions impairs understanding of findings across studies and limits ability to pool results. The OMERACT RA Flare Group sought to identify domains to define RA flares from patient and healthcare professional (HCP) perspectives.
  
  
  METHODS
  Flare was described as a worsening of disease activity of sufficient intensity and duration to consider a change in therapy. International patients and HCPs participated in separate and combined rounds of Delphi exercises to rate candidate flare domains previously generated in patient focus groups. Core domains were defined as those with ≥70% ratings of being 'essential' according to the third/final Delphi exercise.
  
  
  RESULTS
  The final Delphi included 125 RA patients from 10 countries and 108 HCPs from 23 countries who rated 14 domains. Patients had a mean (±SD) age of 56±12 years and disease duration of 18±12 years. HCPs included physicians from clinical practice/research and industry, allied health providers and researchers with 17±11 years experience. Core domains comprised: pain (93%), function (89%), swollen joints (84%), tender joints (81%), participation (81%), stiffness (79%), patient global assessment (76%) and self-management (75%). Fatigue (68%), which did not reach group consensus, will receive additional consideration.
  
  
  CONCLUSIONS
  As part of the process to develop a measure for RA flare, patients and HCPs agreed on eight core domains. Next steps include identifying items to assess domains and conducting studies to validate and refine a new measure.
authors: Department of Medicine, McGill University, Royal Victoria Hospital, Ross 4.31, Montreal, Quebec H3A 1A1, Canada. susan.bartlett@mcgill.ca
authors: Susan J
authors: SJ
authors: Bartlett
authors: Sarah
authors: S
authors: Hewlett
authors: Clifton O
authors: CO
authors: Bingham
authors: Thasia G
authors: TG
authors: Woodworth
authors: Rieke
authors: R
authors: Alten
authors: Christoph
authors: C
authors: Pohl
authors: Ernest H
authors: EH
authors: Choy
authors: Tessa
authors: T
authors: Sanderson
authors: Annelies
authors: A
authors: Boonen
authors: Vivian
authors: V
authors: Bykerk
authors: Amye L
authors: AL
authors: Leong
authors: Vibeke
authors: V
authors: Strand
authors: Daniel E
authors: DE
authors: Furst
authors: Robin
authors: R
authors: Christensen
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology; D032921:Consensus; D003697:Delphi Technique; D059026:Diagnostic Self Evaluation; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006282:Health Personnel; D006304:Health Status; D006801:Humans; D007391:International Cooperation; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D012720:Severity of Illness Index