Friday, 13 Sep 2019

You are here

Flares Portend Damage in Rheumatoid Arthritis - Time for a New Strategy?

Disease flares are common in rheumatoid arthritis (RA), often causing patients to seek additional care, if not medication.

The frequency of flares varies amongst studies in different populations.  But the consequence of flares has only recently been studied.

Italian researchers analyzed 123 RA patients who were initiating therapy with a TNF inhibitor (etanercept or adalimumab) and followed these patients serially over 24 months to assess the frequency of flare and the radiographic impact over time.

The median number of flares was 1.00/year (interquartile range: 0.50; 1.38). Self reported short flares occurred at a rate of 0.50/year (0.14; 1.00). Eighteen patients (12.1 %) had progression of radiographic damage.

Overall flares and short flares were predictive of X-ray progression (OR 3.27, and OR 3.63).

In the BeST trial flare of 500 early RA patients, the prevalence of flare was 4-11 % per visit; 67 % of the patients experienced ≥1 flare during 9 years of treatment.  Flares resulted in decreased functional ability and an increase in disease activity. (Citation source

Those with flares were 70% more likely to have radiographic progression with a dose-response-effect, both during the flare and long term. These authors believed that intensifying treatment during a flare outweighs the risk of possible overtreatment.

Flares are either the result of treatment reductions, noncompliance, inadequate disease control or may be induced by external factors. Regardless of the cause, flares are most often managed with analgesics and steroids.

Given the strong links between flares and radiographic damage, reliance on analgesics or steroids is likely to be short-sighted.  Strategies for flare management beyond steroids and analgesics are needed to avoid unwarranted disease progression.


The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Two vs. Four Weeks of Antibiotic Therapy in Septic Arthritis

A prospective trial has shown that 2 weeks of antibiotic therapy is as effective as 4 weeks of antibiotic therapy, with similar outcomes but shorter hospital stays.

This Swiss study was a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. 

Bimekizumab Add-on Therapy in Rheumatoid Arthritis

Bimekizumab is a dual inhibitor of IL-17A and IL-17F that has been shown to be effective in psoriasis and psoriatic arthritis. A proof-of-concept study shows that giving bimekizumab to rheumatoid arthritis patients not adequately controlled by certolizumab pegol resulted in a rapid decrease in disease activity achieved after 12 weeks of treatment. These findings are novel as anti-IL-17 monoclonal antibody therapy has previously been shown to be ineffective in RA.

74 Percent of Rheumatoid Arthritis Patients Dissatisfied with Treatment

CreakyJoints has completed a 258 patient survey showing that nearly three-fourths of people with rheumatoid arthritis (RA) have expressed dissatisfaction with their treatments, including conventional (csDMARDs) and biologic Disease Modifying Antirheumatic Drugs (bDMARDs).

RA Women are Less Likely to Breastfeed

A large pregnancy registry has published their results showing rheumatoid arthritis (RA) patients who become pregnant are less likely to breastfeed compared to non-RA women from the general population, with many women stopping breastfeeding so that they could start medication, even though many of these meds are safe to use during lactation.

Respiratory Risks Not Increased in RA Patients with COPD

An insurance claims based study of RA patients with COPD shows that biologics do not have an increased rate of respiratory events compared to those on conventional DMARDs. A real world cohort of RA patients with COPD was drawn from US-based MarketScan databases. Patients on biologic DMARDs and/or targeted synthetic DMARDs (tsDMARDs) were propensity matched to those on conventional synthetic DMARDs (csDMARDs).