title: Flares in rheumatoid arthritis: frequency and management. A report from the BRASS registry.
abstract: OBJECTIVE
  To describe the frequency, duration, and management of flares as reported by patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Data were collected in a prospective observational study of patients with RA recruited from a single academic center and treated according to the rheumatologists' discretion. Every 6 months, patients reported the number and duration of RA flares and described how these were managed in terms of adding or changing medication and use of nonpharmacologic strategies.
  
  
  RESULTS
  Of patients who reported flares at least once during the study, 74% reported having flares 6 months prior to study entry and 59% reported flares prior to the first 6-month visit. At subsequent visits, 54-57% reported having > 1 flare. Thirty percent of patients in remission reported flares. Flare duration lasted ≥ 2 weeks in 30%, 1-2 weeks in 13%, and < 1 week in 57%. Forty percent reported medication changes at the time of their flare; 16% changed medication and used nonpharmacologic strategies and 26% of patients reported no changes in treatment as a result of flares. Longer duration of flare was associated with changes in disease-modifying therapy.
  
  
  CONCLUSIONS
  Patients with RA experienced flares more often when noted to be in higher disease activity states than when in remission and reported changes in disease-modifying antirheumatic drugs or biologics more frequently when flares were of longer duration. There is a need to prospectively study symptom intensity and duration of flare in relation to disease activity and consider self-management strategies in the development of a measure of flare.
authors: From the Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical School, New York, New York; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Touro College of Osteopathic Medicine, New York, New York, USA.
authors: Vivian P
authors: VP
authors: Bykerk
authors: Nancy
authors: N
authors: Shadick
authors: Michelle
authors: M
authors: Frits
authors: Clifton O
authors: CO
authors: Bingham
authors: Iain
authors: I
authors: Jeffery
authors: Christine
authors: C
authors: Iannaccone
authors: Michael
authors: M
authors: Weinblatt
authors: Daniel H
authors: DH
authors: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: DISEASE MANAGEMENT; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; FLARES; RHEUMATOID ARTHRITIS