Affordable Access

deepdyve-link
Publisher Website

Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, and Medication Change.

Authors
  • Mahmoud, Taysir G1, 2
  • Huang, Jie3, 4
  • Frits, Michelle3, 4
  • Iannaccone, Christine3, 4
  • Bykerk, Vivian3, 4
  • Bingham, Clifton O 3rd3, 4
  • Weinblatt, Michael3, 4
  • Shadick, Nancy A3, 4
  • 1 From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. [email protected]
  • 2 T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School. [email protected]
  • 3 From the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • 4 T.G. Mahmoud, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J. Huang, MS, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; M. Frits, BA, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; C. Iannaccone, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; V. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery; C.O. Bingham III, MD, Division of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University School of Medicine; M. Weinblatt, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; N.A. Shadick, MD, MPH, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School.
Type
Published Article
Journal
The Journal of Rheumatology
Publisher
The Journal of Rheumatology
Publication Date
Mar 01, 2020
Volume
47
Issue
3
Pages
333–340
Identifiers
DOI: 10.3899/jrheum.181160
PMID: 31203222
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome. Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome. Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7-2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68-7.21) and having lower flare pain (OR 0.83, 95% CI 0.71-0.97) were associated with better flare outcome. Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes.

Report this publication

Statistics

Seen <100 times