Clinical Edge

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Flare Management in Patients with Rheumatoid Arthritis

A flare management intervention in patients with rheumatoid arthritis (RA) offering telephone nurse-led counseling, or an expedited visit by a rheumatology provider, did not have any major effect on flare occurrence or RA disease activity metrics over 24-month follow-up, a new study found. Adult patients with established RA were randomized to the intervention arm (n=75) vs usual care (n=75). The questionnaire was administered monthly during 24 months to all patients in the intervention arm to determine flare status. Researchers found:

  • RA flare was reported on 19% of the questionnaires; average FLARE-RA score, 4.72 on 0 (no flare) to 10 (maximum flare) scale.
  • Patients preferred an expedited clinic visit with a rheumatology provider during 32% of flares.
  • The majority of patients in the intervention arm preferred self-management to an expedited visit with their rheumatology provider.

Citation:

Myasoedova, et al. Optimization of flare management in patients with rheumatoid arthritis: Results of a randomized controlled trial. [Published online ahead of print July 1, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04664-5.

Commentary:

RA is characterized by intermittent flares that contribute greatly to disease burden and disability. While some RA patients are comfortable self-managing flares, optimal management and patient preferences regarding limited resources (including access to timely rheumatology care) are unknown. In this study, 150 RA patients were randomized 1:1 to an intervention of nurse-led counseling or expedited rheumatology visit vs usual care. Patients in the intervention arm received monthly questionnaires and 47/75 reported at least 1 flare, with a comparable rate in the usual care group. There were no differences between the groups in terms of clinical disease activity scores. Of note, despite being offered expedited care with a rheumatology provider, most patients preferred to self-manage flares. It is possible that despite patients’ preferences to see providers in an expedited manner, the associated costs and burdens may act as a barrier to the ideal. —Arundathi Jayatilleke, MD