Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire

Elena Myasoedova, Annette De Thurah, Marie Line Erpelding, Emilce E. Schneeberger, Thomas Maribo, Gustavo Citera, John Manley III Davis, Eric L. Matteson, Cynthia Crowson, Bruno Fautrel, Francis Guillemin

Research output: Contribution to journalArticle

Abstract

Objective: The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was devised for the detection of flares in patients with RA. We aimed to define construct validity and cut-off(s) for the FLARE-RA questionnaire. Methods: This cross-sectional study included adult patients with prevalent RA (2010 ACR/EULAR criteria) attending outpatient rheumatology clinics in France (n = 138), Denmark (n = 253), USA (n = 75), and Argentina (n = 105). Flare occurrence over the past 3 months was assessed with the FLARE-RA questionnaire scoring from 0 (no flare) to 10 (maximum flare). The cut-offs for the FLARE-RA score were defined using the following anchor items obtained at the same encounter: (1) Patient report of flare; (2) DAS28-CRP > 3.2; (3) Change of anti-rheumatic treatment, based on the area under the receiver operating characteristic curve (AUC) and distance to (0,1). Results: Four hundred seventy four patients with RA duration ≥2 years (mean age 58.6 years, 74.9% female) were included in the main analysis. The discrimination for the FLARE-RA cut-offs was acceptable-to-excellent: AUC for the global FLARE-RA score ranged from 0.71 to 0.92. The cut-offs for the FLARE-RA score were lower using “patient report of flare” than DAS28-CRP and “change of anti-rheumatic treatment”. Proposed FLARE-RA cut-offs for clinical detection and change of anti-rheumatic treatment are 2 and 5, respectively, for patients with RA duration 2–5 years, and 2 and 3.5, respectively, for patients with RA duration >5 years. Conclusions: Proposed FLARE-RA cut-offs have acceptable discriminative capacity across the tested anchor items and are expected to aid in early recognition and timely management of RA flares.

Original languageEnglish (US)
JournalSeminars in Arthritis and Rheumatism
DOIs
StateAccepted/In press - Jan 1 2019

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Rheumatoid Arthritis
Area Under Curve
Surveys and Questionnaires
Argentina
Rheumatology
Denmark
Ambulatory Care Facilities
ROC Curve
France
Therapeutics
Cross-Sectional Studies

Keywords

  • Flare
  • Rheumatoid arthritis
  • Self-assessment

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire. / Myasoedova, Elena; De Thurah, Annette; Erpelding, Marie Line; Schneeberger, Emilce E.; Maribo, Thomas; Citera, Gustavo; Davis, John Manley III; Matteson, Eric L.; Crowson, Cynthia; Fautrel, Bruno; Guillemin, Francis.

In: Seminars in Arthritis and Rheumatism, 01.01.2019.

Research output: Contribution to journalArticle

Myasoedova, Elena ; De Thurah, Annette ; Erpelding, Marie Line ; Schneeberger, Emilce E. ; Maribo, Thomas ; Citera, Gustavo ; Davis, John Manley III ; Matteson, Eric L. ; Crowson, Cynthia ; Fautrel, Bruno ; Guillemin, Francis. / Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire. In: Seminars in Arthritis and Rheumatism. 2019.
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abstract = "Objective: The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was devised for the detection of flares in patients with RA. We aimed to define construct validity and cut-off(s) for the FLARE-RA questionnaire. Methods: This cross-sectional study included adult patients with prevalent RA (2010 ACR/EULAR criteria) attending outpatient rheumatology clinics in France (n = 138), Denmark (n = 253), USA (n = 75), and Argentina (n = 105). Flare occurrence over the past 3 months was assessed with the FLARE-RA questionnaire scoring from 0 (no flare) to 10 (maximum flare). The cut-offs for the FLARE-RA score were defined using the following anchor items obtained at the same encounter: (1) Patient report of flare; (2) DAS28-CRP > 3.2; (3) Change of anti-rheumatic treatment, based on the area under the receiver operating characteristic curve (AUC) and distance to (0,1). Results: Four hundred seventy four patients with RA duration ≥2 years (mean age 58.6 years, 74.9{\%} female) were included in the main analysis. The discrimination for the FLARE-RA cut-offs was acceptable-to-excellent: AUC for the global FLARE-RA score ranged from 0.71 to 0.92. The cut-offs for the FLARE-RA score were lower using “patient report of flare” than DAS28-CRP and “change of anti-rheumatic treatment”. Proposed FLARE-RA cut-offs for clinical detection and change of anti-rheumatic treatment are 2 and 5, respectively, for patients with RA duration 2–5 years, and 2 and 3.5, respectively, for patients with RA duration >5 years. Conclusions: Proposed FLARE-RA cut-offs have acceptable discriminative capacity across the tested anchor items and are expected to aid in early recognition and timely management of RA flares.",
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T1 - Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire

AU - Myasoedova, Elena

AU - De Thurah, Annette

AU - Erpelding, Marie Line

AU - Schneeberger, Emilce E.

AU - Maribo, Thomas

AU - Citera, Gustavo

AU - Davis, John Manley III

AU - Matteson, Eric L.

AU - Crowson, Cynthia

AU - Fautrel, Bruno

AU - Guillemin, Francis

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was devised for the detection of flares in patients with RA. We aimed to define construct validity and cut-off(s) for the FLARE-RA questionnaire. Methods: This cross-sectional study included adult patients with prevalent RA (2010 ACR/EULAR criteria) attending outpatient rheumatology clinics in France (n = 138), Denmark (n = 253), USA (n = 75), and Argentina (n = 105). Flare occurrence over the past 3 months was assessed with the FLARE-RA questionnaire scoring from 0 (no flare) to 10 (maximum flare). The cut-offs for the FLARE-RA score were defined using the following anchor items obtained at the same encounter: (1) Patient report of flare; (2) DAS28-CRP > 3.2; (3) Change of anti-rheumatic treatment, based on the area under the receiver operating characteristic curve (AUC) and distance to (0,1). Results: Four hundred seventy four patients with RA duration ≥2 years (mean age 58.6 years, 74.9% female) were included in the main analysis. The discrimination for the FLARE-RA cut-offs was acceptable-to-excellent: AUC for the global FLARE-RA score ranged from 0.71 to 0.92. The cut-offs for the FLARE-RA score were lower using “patient report of flare” than DAS28-CRP and “change of anti-rheumatic treatment”. Proposed FLARE-RA cut-offs for clinical detection and change of anti-rheumatic treatment are 2 and 5, respectively, for patients with RA duration 2–5 years, and 2 and 3.5, respectively, for patients with RA duration >5 years. Conclusions: Proposed FLARE-RA cut-offs have acceptable discriminative capacity across the tested anchor items and are expected to aid in early recognition and timely management of RA flares.

AB - Objective: The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was devised for the detection of flares in patients with RA. We aimed to define construct validity and cut-off(s) for the FLARE-RA questionnaire. Methods: This cross-sectional study included adult patients with prevalent RA (2010 ACR/EULAR criteria) attending outpatient rheumatology clinics in France (n = 138), Denmark (n = 253), USA (n = 75), and Argentina (n = 105). Flare occurrence over the past 3 months was assessed with the FLARE-RA questionnaire scoring from 0 (no flare) to 10 (maximum flare). The cut-offs for the FLARE-RA score were defined using the following anchor items obtained at the same encounter: (1) Patient report of flare; (2) DAS28-CRP > 3.2; (3) Change of anti-rheumatic treatment, based on the area under the receiver operating characteristic curve (AUC) and distance to (0,1). Results: Four hundred seventy four patients with RA duration ≥2 years (mean age 58.6 years, 74.9% female) were included in the main analysis. The discrimination for the FLARE-RA cut-offs was acceptable-to-excellent: AUC for the global FLARE-RA score ranged from 0.71 to 0.92. The cut-offs for the FLARE-RA score were lower using “patient report of flare” than DAS28-CRP and “change of anti-rheumatic treatment”. Proposed FLARE-RA cut-offs for clinical detection and change of anti-rheumatic treatment are 2 and 5, respectively, for patients with RA duration 2–5 years, and 2 and 3.5, respectively, for patients with RA duration >5 years. Conclusions: Proposed FLARE-RA cut-offs have acceptable discriminative capacity across the tested anchor items and are expected to aid in early recognition and timely management of RA flares.

KW - Flare

KW - Rheumatoid arthritis

KW - Self-assessment

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