Optimization of flare management in patients with rheumatoid arthritis: results of a randomized controlled trial

Elena Myasoedova, Cynthia S. Crowson, Rachel E. Giblon, Kathleen McCarthy-Fruin, Daniel E. Schaffer, Kerry Wright, Eric L. Matteson, John M. Davis

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Introduction/objectives: To evaluate the effect of a flare management intervention guided by non-physician providers versus usual care between rheumatology visits on flare occurrence and rheumatoid arthritis (RA) disease activity. Methods: Adult patients with established RA (per 2010 ACR criteria, n = 150) were randomized to the intervention arm (n = 75) versus usual care (n = 75). The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was administered monthly during 24 months to all patients in the intervention arm to assess flare status. Telephone nurse-led counseling or an expedited visit with a rheumatology provider was offered to patients in the intervention arm who indicated they were in flare. Results: Patients in the intervention arm completed a median of 8.5 (range 1–24) questionnaires. RA flare was reported on 122 (19%) of these 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 39 (32%) of flares. The majority of patients preferred to self-manage their flare (76, 62%); some patients received nursing advice on flare management over the phone (7, 6%). There were no differences in RA flare by OMERACT9 definition, DAS28-CRP, CDAI, SDAI, anti-rheumatic treatment change by rheumatology provider, or remission by CDAI between the study arms over 24-month follow-up. Conclusions: The flare management intervention did not have any major effect on flare occurrence or RA disease activity metrics over the 24-month follow-up. The majority of patients in the intervention arm preferred self-management to an expedited visit with their rheumatology provider. Trial registration: ClinicalTrials.gov Identifier: NCT02382783 (https://clinicaltrials.gov/ct2/show/NCT02382783)

Original languageEnglish (US)
Pages (from-to)3025-3032
Number of pages8
JournalClinical rheumatology
Volume38
Issue number11
DOIs
StatePublished - Nov 1 2019

Keywords

  • Flare
  • Randomized controlled trial
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

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