title: Patient-reported Flares in Ankylosing Spondylitis: A Cross-sectional Analysis of 234 Patients.
abstract: Ankylosing spondylitis (AS) is characterized by periodic flares. The objective of this study was to assess the frequency of patient-reported flares and their related factors.
  
  
  
  This cross-sectional study analyzed the 2004 data of a Canadian cohort. Participants had AS according to the modified New York criteria. Current flare status ("Are you experiencing a current flare"?), number of flares over the past 3 months, their average duration, the Bath Ankylosing Spondylitis Disease Activity and Functional Index (BASDAI and BASFI, respectively), and the AS Quality of Life questionnaire were assessed by self-report. Univariate and multivariate regressions analyzed the factors associated with current flare.
  
  
  
  Among 234 analyzed patients, 169 (73.5%) were men, mean age was 45.5 (± 11.8) years, mean disease duration of 21.7 (± 11.7) years, and mean BASDAI and BASFI (0-10) of 4.4 (± 2.3) and 3.4 (± 2.6), respectively; 18 (7.7%) received antitumor necrosis factor (anti-TNF). Overall, 175 patients (74.8%) reported flares and 117 (50%) were currently in flare. Patients reporting flares had a median of 3 flares in 3 months, with a median duration of 2 weeks. Overall, the 234 patients spent a median of 25% of their time in flare. In multivariate analyses, current flare was significantly associated with higher BASDAI (OR 2.01, p = 0.01), worse quality of life (OR 1.37, p = 0.004), shorter AS duration (OR 1.19, p = 0.04), and less anti-TNF (OR 7.14, p = 0.03).
  
  
  
  In this population, before the wide use of biologics, flares were frequent and long. As expected, flare was associated with higher disease activity, suggesting the validity of the concept of patient-reported flares.
authors.affiliation: From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.|Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.|C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jacquemin
authors.affiliation: From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.|Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.|C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
authors.affiliation: From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands.|Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France.|C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.affiliation: From the UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France; University of Alberta, Department of Medicine, Edmonton, Alberta, Canada; Maastricht University Medical Center, Department of Rheumatology, Maastricht, the Netherlands. laure.gossec@aphp.fr.|Dr. W.P. Maksymowych received research grants from Abbvie, Janssen, and Pfizer, and honoraria from Abbvie, Eli-Lilly, and Pfizer. Dr. L. Gossec received research grants from Pfizer France and Lilly France. laure.gossec@aphp.fr.|C. Jacquemin, MD, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology; W.P. Maksymowych, FRCP(C), University of Alberta, Department of Medicine; A. Boonen, MD, PhD, Maastricht University Medical Center, Department of Rheumatology; L. Gossec, MD, PhD, Professor, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and APHP, Pitié-Salpêtrière Hospital, Department of Rheumatology. laure.gossec@aphp.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: ANKYLOSING SPONDYLITIS; DISEASE ACTIVITY; SELF-ASSESSMENT