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

Elena Myasoedova, Cynthia Crowson, Rachel E. Giblon, Kathleen McCarthy-Fruin, Daniel E. Schaffer, Kerry Wright, Eric Lawrence Matteson, John Manley III Davis

Research output: Contribution to journalArticle

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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)
JournalClinical rheumatology
DOIs
StatePublished - Jan 1 2019

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Rheumatoid Arthritis
Randomized Controlled Trials
Rheumatology
Ambulatory Care
Self Care
Telephone
Counseling
Nursing
Nurses
Surveys and Questionnaires

Keywords

  • Flare
  • Randomized controlled trial
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

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Optimization of flare management in patients with rheumatoid arthritis : results of a randomized controlled trial. / Myasoedova, Elena; Crowson, Cynthia; Giblon, Rachel E.; McCarthy-Fruin, Kathleen; Schaffer, Daniel E.; Wright, Kerry; Matteson, Eric Lawrence; Davis, John Manley III.

In: Clinical rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

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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).",
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AU - Myasoedova, Elena

AU - Crowson, Cynthia

AU - Giblon, Rachel E.

AU - McCarthy-Fruin, Kathleen

AU - Schaffer, Daniel E.

AU - Wright, Kerry

AU - Matteson, Eric Lawrence

AU - Davis, John Manley III

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N2 - 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).

AB - 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).

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