What signs predict a flare in rheumatoid arthritis?

This study investigated if there are factors that predict if a patient will have a flare in rheumatoid arthritis (RA). They found that patients with worse disease activity, functional disability, and quality of life were more likely to experience flares.

Rheumatoid arthritis (RA) is a chronic (long-term), inflammatory condition. The aim of treatment is to reduce disease activity to the lowest level. This is called low disease activity (LDA) state.

Disease activity can worsen for periods of time. These periods are described as “flares”. Flares can indicate that RA is getting worse. Flares are associated with worse disease activity and increased risk to the patient. Predicting flares is important to manage RA symptoms and slow disease progression. 

This study included 152 patients with LDA or remission from RA. The study lasted 12 months. Patients underwent assessment at the beginning of the study and every 3 months. Disease activity and the number of flares were recorded. Samples were taken to measure the levels of inflammatory chemicals in the blood. Patients were assessed for functional disability and quality of life using questionnaires.

30% of patients experienced a flare within 12 months. Functional disability at the beginning of the study was associated with an 82% higher risk of flares. Worse disease activity and quality of life were associated with flares. The HAQ-DI (Health Assessment Questionnaire–Disability Index) questionnaire was the most reliable predictor of flares. Higher scores predicted a 76% greater risk of flares.

The authors concluded that patients with worse disease activity, functional disability, and quality of life were more likely to experience flares.

The number of patients in this study was relatively small. They did not measure flares outside of regular clinic appointments. This was an observational study so patients were on varying drug regimens. This may also have influenced the number of flares.

If you have any concerns about managing RA please discuss this with your doctor.