Monday, 20 Jan 2020

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

Best of 2019 - War on RA - Part 1: Walk on the Moon

It’s a great time to be a rheumatologist and to manage RA. But, if you keep doing what you’re doing, you’re going to keep getting what you’ve got.

Best of 2019 - War on RA - Part 3: Useless Drugs

We have options that are endless – we have 28 biologics in rheumatology; 19 approved for RA in the last 20 years, but 15 of these are me-too copies or biosimilars. We currently have 2 JAK inhibitors and may have 3 or 4 by year end. But what we really need is the right drug, at the right time, in the right patient – but how will we know.

Link Between Obstructive Lung Disease and Developing RA?

We all know that the microbiome in the gut may be very important for multiple immune diseases. However, new findings from the ACR, 2019 in Atlanta reinforce how important the interface is between the lungs and developing rheumatoid arthritis.

Smoking Cessation Lowers RA Disease Activity and CV Risks

A multinational cross-sectional cohort study suggests that smoking cessation in rheumatoid arthritis (RA) patients is associated with lower disease activity measures, improved lipid profiles and lower rates of cardiovascular (CV) events.

Apremilast Reduces Oral Ulcers in Behcet's Syndrome

A multinational trial finds a statistically significant number of patients with Behçet's syndrome showed a greater reduction in the number of oral ulcers with apremilast compared with placebo.