title: Self-reported flares are predictors of radiographic progression in rheumatoid arthritis patients in 28-joint disease activity score remission: a 24-month observational study.
abstract: BACKGROUND
  Disease flares are common in rheumatoid arthritis (RA) and are related to structural damage. However, few data on the impact of flares reported by patients on radiographic progression are available. Our aim was to investigate whether overall flares (OF), self-reported flares (SRF) and short flares assessed at the visit (SF) predict radiographic progression in RA patients in DAS28 (28-joint disease activity score) remission.
  
  
  METHODS
  We reviewed the records of RA patients included in our database. We considered all patients who had a period of at least 24 months in remission (DAS28 < 2.6), stable biologic and synthetic disease-modifying anti-rheumatic drug treatment, no missing follow-up visits and hands and feet radiographs at the start and at the end of the 24-month follow up. Radiographic progression was considered as an increase in the van der Heijde modified total Sharp score >0. Patients were assessed every 3 months and flares were recorded. We defined SRF as any worsening of the disease reported by patients occurring in the time between visits and SF as an increase in DAS28 ≥ 2.6 or >0.6 from the previous visit assessed by the physician in one isolated visit. The impact of SRF, SF and OF on radiographic progression was assessed through multivariate regression analysis.
  
  
  RESULTS
  One hundred forty-nine patients were included. The median number (interquartile range) of OF was 1.00/year (0.50; 1.38), of SRF was 0.50/year (0.14; 1.00), and of SF was 0.34/year (0; 0.50). Eighteen patients (12.1 %) experienced a progression of radiographic damage. OF and SRF were significant predictors of radiographic progression: OR 3.27, 95 % CI 1.30, 8.22 and OR 3.63, 95 % CI 1.16, 11.36, respectively.
  
  
  CONCLUSIONS
  OF and SRF are predictors of structural damage. Flares assessed at the visit, SF, do not impact on radiographic progression as they might underestimate the actual number of flares.
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ometto
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.|Rheumatology Unit, Department of Medicine, Bolzano General Hospital, Via Lorenz Bohler, 5, 39100, Bolzano, Italy.
authors.forename: Bernd
authors.initials: B
authors.lastname: Raffeiner
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Bernardi
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Bostsios
authors.affiliation: Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.|Institute of clinical Research and Education in Medicine (IREM), Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy. adoria@unipd.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001175:Arthrography; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D057566:Self Report
chemical_list: D018501:Antirheumatic Agents
keywords: Biologic treatment; DAS28 remission; Flares; Radiographic progression; Rheumatoid arthritis; Self-reported flares