Association between rheumatoid arthritis flares and joint structural changes at 24 months.

Objective: To describe whether rheumatoid arthritis (RA) flares detected by the self-administered Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire can predict joint structural damage progression at 2 years and to explore the association between the FLARE-RA score and RA outcome measures.

Methods: Adults with RA for less than 10 years and Health Assessment Questionnaire-Disability Index (HAQ-DI) score <1 were included in this prospective observational study. Patients were followed clinically every 6 months and completed the FLARE-RA questionnaire every 3 months at home, for 24 months. Wrist and foot X-rays were taken at inclusion and month 24 (M24). Logistic regressions and generalized linear mixed-effects models were used.

Results: The median (IQR) age of the 221 analyzed patients was 58.0 years (48.0-66.0), 67.4% were female, and the median time from RA diagnosis was 1.4 years (0.5-2.8). Most patients (84.6%) received ongoing treatment for RA, and 46.0% were in remission according to the Disease Activity Score in 28 joints (DAS28) at inclusion. Flare assessment between visits to the rheumatologist, as assessed with the FLARE-RA global score was not associated with structural changes (OR: 1.00, 95% CI 0.99-1.01) or progression of erosions (OR=1.00, 95% CI 0.99-1.01) at month 24 but was significantly associated with DAS28, Physician Global Assessment, HAQ-DI, Patient Acceptable Symptom State, Minimal Clinically Important Difference, and intensification of treatment for RA during follow-up (all p <0.0001).

Conclusions: The FLARE-RA score was associated with physician-based disease activity measures, suggesting its value as a patient-reported disease-activity measure in routine care, including remote consultation.