Questionnaire May Help Tweak RA Treatment Based on Flare

A new questionnaire that takes into consideration both patient and physician perspectives is designed to detect rheumatoid arthritis flares in between appointments, and also may enable patients to self-detect flare and immediately seek an appointment, according to a review of the tool published online Nov. 9 in Annals of the Rheumatic Diseases.

There is a lack of consensus about how to define and measure flare. For some, flares happen in the context of RA worsening over a significant period. This definition of flare does not take into consideration transient exacerbations that spontaneously resolve. Others define flare as any exacerbation, whether transient or long lasting.

At the same time, physicians tend to define flare based on objective signs and clinical features, while patients perceive flare according to symptoms and their effects on daily living.

The Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire melds both patient and physician perspectives, transient and present flares, explained Dr. Jean-Marie Berthelot, of the University of Nantes (France).

The self-administered part of the instrument was based on patient interviews, the findings from which were systematically analyzed to identify attributes patients most commonly used to describe RA flare and the frequency.

In all, 61% of the 99 patients interviewed reported that a flare usually starts with a feeling of swelling in the joints, and 11% mentioned frozen joints. All respondents reported increased pain of varying levels and an increased daily intake of analgesics. Other characteristics included depression (67%), sleep disturbances (77%), and increased fatigue (91%). Also, 96% reported repercussions on daily activities, 88% reported feeling a loss of independence, and 91% reported feeling more fragile emotionally during the flare. Only 9% reported flu-like symptoms.

"From this content analysis, we selected 10 domains to describe RA flare, according to the patient perspective," the researchers explained.

For the physician assessment part of the instrument, 13 rheumatologists participated in a Delphi exercise in which the researchers asked each to list 10 elements that best reflected RA flares. The researchers organized these into domains and eliminated items during a four-round Delphi process in which they selected items only when cited by at least 75% of the participants.

The patients and physicians had four domains in common: joint swelling, pain, sleep disturbance, and intake of analgesics. The common domains were merged, and the remaining domains also were included in the FLARE questionnaire.

However, several issues must be resolved. For example, a threshold of disease worsening is needed to define flare. Also, clarification about the duration of symptom exacerbation is necessary.

The tool needs to be validated in a prospective trial before it can be used to more tightly adjust treatment "based on the overall activity of RA between two visits," the investigators concluded. Once validated "it should be suitable for clinical research and might be for daily clinical practice," they wrote (Ann. Rheum. Dis. 2011 Nov. 9 [doi: 10.1136/ard.2011.150656]).

The study was funded by an unrestricted grant from Sanofi-Aventis France, but the company had no access to the data and was not involved in the study design or data analysis. The authors reported having no conflicts to disclose.

A new questionnaire that takes into consideration both patient and physician perspectives is designed to detect rheumatoid arthritis flares in between appointments, and also may enable patients to self-detect flare and immediately seek an appointment, according to a review of the tool published online Nov. 9 in Annals of the Rheumatic Diseases.

There is a lack of consensus about how to define and measure flare. For some, flares happen in the context of RA worsening over a significant period. This definition of flare does not take into consideration transient exacerbations that spontaneously resolve. Others define flare as any exacerbation, whether transient or long lasting.

At the same time, physicians tend to define flare based on objective signs and clinical features, while patients perceive flare according to symptoms and their effects on daily living.

The Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire melds both patient and physician perspectives, transient and present flares, explained Dr. Jean-Marie Berthelot, of the University of Nantes (France).

The self-administered part of the instrument was based on patient interviews, the findings from which were systematically analyzed to identify attributes patients most commonly used to describe RA flare and the frequency.

In all, 61% of the 99 patients interviewed reported that a flare usually starts with a feeling of swelling in the joints, and 11% mentioned frozen joints. All respondents reported increased pain of varying levels and an increased daily intake of analgesics. Other characteristics included depression (67%), sleep disturbances (77%), and increased fatigue (91%). Also, 96% reported repercussions on daily activities, 88% reported feeling a loss of independence, and 91% reported feeling more fragile emotionally during the flare. Only 9% reported flu-like symptoms.

"From this content analysis, we selected 10 domains to describe RA flare, according to the patient perspective," the researchers explained.

For the physician assessment part of the instrument, 13 rheumatologists participated in a Delphi exercise in which the researchers asked each to list 10 elements that best reflected RA flares. The researchers organized these into domains and eliminated items during a four-round Delphi process in which they selected items only when cited by at least 75% of the participants.

The patients and physicians had four domains in common: joint swelling, pain, sleep disturbance, and intake of analgesics. The common domains were merged, and the remaining domains also were included in the FLARE questionnaire.

However, several issues must be resolved. For example, a threshold of disease worsening is needed to define flare. Also, clarification about the duration of symptom exacerbation is necessary.

The tool needs to be validated in a prospective trial before it can be used to more tightly adjust treatment "based on the overall activity of RA between two visits," the investigators concluded. Once validated "it should be suitable for clinical research and might be for daily clinical practice," they wrote (Ann. Rheum. Dis. 2011 Nov. 9 [doi: 10.1136/ard.2011.150656]).

The study was funded by an unrestricted grant from Sanofi-Aventis France, but the company had no access to the data and was not involved in the study design or data analysis. The authors reported having no conflicts to disclose.

A new questionnaire that takes into consideration both patient and physician perspectives is designed to detect rheumatoid arthritis flares in between appointments, and also may enable patients to self-detect flare and immediately seek an appointment, according to a review of the tool published online Nov. 9 in Annals of the Rheumatic Diseases.

There is a lack of consensus about how to define and measure flare. For some, flares happen in the context of RA worsening over a significant period. This definition of flare does not take into consideration transient exacerbations that spontaneously resolve. Others define flare as any exacerbation, whether transient or long lasting.

At the same time, physicians tend to define flare based on objective signs and clinical features, while patients perceive flare according to symptoms and their effects on daily living.

The Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire melds both patient and physician perspectives, transient and present flares, explained Dr. Jean-Marie Berthelot, of the University of Nantes (France).

The self-administered part of the instrument was based on patient interviews, the findings from which were systematically analyzed to identify attributes patients most commonly used to describe RA flare and the frequency.

In all, 61% of the 99 patients interviewed reported that a flare usually starts with a feeling of swelling in the joints, and 11% mentioned frozen joints. All respondents reported increased pain of varying levels and an increased daily intake of analgesics. Other characteristics included depression (67%), sleep disturbances (77%), and increased fatigue (91%). Also, 96% reported repercussions on daily activities, 88% reported feeling a loss of independence, and 91% reported feeling more fragile emotionally during the flare. Only 9% reported flu-like symptoms.

"From this content analysis, we selected 10 domains to describe RA flare, according to the patient perspective," the researchers explained.

For the physician assessment part of the instrument, 13 rheumatologists participated in a Delphi exercise in which the researchers asked each to list 10 elements that best reflected RA flares. The researchers organized these into domains and eliminated items during a four-round Delphi process in which they selected items only when cited by at least 75% of the participants.

The patients and physicians had four domains in common: joint swelling, pain, sleep disturbance, and intake of analgesics. The common domains were merged, and the remaining domains also were included in the FLARE questionnaire.

However, several issues must be resolved. For example, a threshold of disease worsening is needed to define flare. Also, clarification about the duration of symptom exacerbation is necessary.

The tool needs to be validated in a prospective trial before it can be used to more tightly adjust treatment "based on the overall activity of RA between two visits," the investigators concluded. Once validated "it should be suitable for clinical research and might be for daily clinical practice," they wrote (Ann. Rheum. Dis. 2011 Nov. 9 [doi: 10.1136/ard.2011.150656]).

The study was funded by an unrestricted grant from Sanofi-Aventis France, but the company had no access to the data and was not involved in the study design or data analysis. The authors reported having no conflicts to disclose.