Flares in Rheumatoid Arthritis: Frequency and Management. A Report from the BRASS Registry
Flares in Rheumatoid Arthritis: Frequency and Management. A Report from the BRASS Registry
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DOI：
10.3899/jrheum.121521
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发表时间：
2014-02-01
影响因子：
3.9
通讯作者：
Solomon, Daniel H.
中科院分区：
文献类型：
--
作者：
Bykerk, Vivian P.;Shadick, Nancy;Solomon, Daniel H.
Objective.描述类风湿性关节炎（RA）患者报告的发作频率、持续时间和处理。在一项前瞻性观察性研究中收集了来自一个学术中心的RA患者的数据，并根据风湿病学家的判断进行治疗。患者每6个月报告一次类风湿关节炎发作的次数和持续时间，并描述如何通过增加或改变药物治疗和使用非药物治疗策略来管理。在研究期间至少报告一次发作的患者中，74%的患者在进入研究前6个月报告发作，59%的患者在首次6个月访视前报告发作。在随后的访视中，54-57%报告有> 1次发作。30%的缓解期患者报告发作。30%的患者耀斑持续时间>= 2周，13%的患者耀斑持续时间为1-2周，57%的患者耀斑持续时间< 1周。40%的患者在发作时报告药物变化; 16%的患者改变药物并使用非药物策略，26%的患者报告由于发作而未改变治疗。较长的发作持续时间与疾病改善治疗的变化相关。RA患者在疾病活动性较高的状态下比缓解期更常发生发作，并且在发作持续时间较长时更常报告病情缓解抗风湿药物或生物制剂的变化。有必要前瞻性地研究症状强度和发作持续时间与疾病活动的关系，并在制定发作措施时考虑自我管理策略。
Objective. To describe the frequency, duration, and management of flares as reported by patients with rheumatoid arthritis (RA).Methods. Data were collected in a prospective observational study of patients with RA recruited from a single academic center and treated according to the rheumatologists' discretion. Every 6 months, patients reported the number and duration of RA flares and described how these were managed in terms of adding or changing medication and use of nonpharmacologic strategies.Results. Of patients who reported flares at least once during the study, 74% reported having flares 6 months prior to study entry and 59% reported flares prior to the first 6-month visit. At subsequent visits, 54-57% reported having > 1 flare. Thirty percent of patients in remission reported flares. Flare duration lasted >= 2 weeks in 30%, 1-2 weeks in 13%, and < 1 week in 57%. Forty percent reported medication changes at the time of their flare; 16% changed medication and used nonpharmacologic strategies and 26% of patients reported no changes in treatment as a result of flares. Longer duration of flare was associated with changes in disease-modifying therapy.Conclusion. Patients with RA experienced flares more often when noted to be,in higher disease activity states than when in remission and reported changes in disease-modifying antirheumatic drugs or biologics more frequently when flares were of longer duration. There is a need to prospectively study symptom intensity and duration of flare in relation to disease activity and consider self-management strategies in the development of a measure of flare.