Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Development by the STPR Group of the Flare Instument, a New Tool To Identify Flare in Rheumatoid Arthritis (RA) in Clinical Practice.

Berthelot4,  Jean-Marie, De Bandt2,  Michel, Morel1,  Jacques, Constantin3,  Arnaud, Gaudin3,  Philippe, Le Loet3,  Xavier, Maillefert3,  Jean-Francis

Montpellier, France
Aulnay Sous Bois, France
Rheumatology Unit CHU Nantes, Nantes, France


Rheumatoid arthritis (RA) patients may have stable disease activity at two determinations but flares may occur between two scheduled evaluations, not captured by any activity score. There is no measure for such flares in RA patients, although they could impact on radiographic and functional outcome.


To explore the concept of flare (transient or lasting exacerbation of disease activity) in clinical practice in RA, from both patient's and rheumatologist's perspectives, and to develop a self-administered questionnaire enabling the prospective or retrospective detection of flare(s) in the timeframe between two medical visits.


To capture the patient perspective, 105 established RA patients from 12 rheumatology centres were proposed to participate in an individual, semi-structured interview scheduled to record their feeling about flare. Content analysis was used to identify verbatim and derive candidate items. The most representative and frequently reported items were selected. To explore the physician perspective, 13 RA-experienced physicians from the STPR (Strategy of Treatment in Patients with Rheumatoid arthritis) panel, participated to a Delphi exercise. They were asked to list the signs or symptoms best reflecting RA flare(s) from their point of view. The items listed were reduced in a 5-round Delphi process in which all items cited by at least 75% were definitively selected and those cited by less than 25% of the respondents were excluded.


In the patient perspective, 10 items were selected: swollen joints, fatigue, unbearable pain, pain-killer intake, night awakening, being restricted to inaction, need for help, wish to be alone, drop in mood, irritability. They were integrated in a self-administered questionnaire presenting items with Likert scale-type response frame. In the physician perspective, 9 items were identified: morning stiffness, night awakening, joint swelling, raise in ESR or CRP, worsening of nightly or morning pain, deterioration in arthritis, increase in corticosteroid intake, increase in pain-killer intake, feeling of a flare. They were presented with discrete answers. Four dimensions were common to physicians and patients: joint swelling, pain, sleep disturbance, increase in pain killer intakes.


The study enabled the identification of 15 different items and will allow the construction of a self-administered questionnaire potentially able to detect flares between two medical evaluations in clinical practice, regardless any disease activity index.

To cite this abstract, please use the following information:
Berthelot, Jean-Marie, De Bandt, Michel, Morel, Jacques, Constantin, Arnaud, Gaudin, Philippe, Le Loet, Xavier, et al; Development by the STPR Group of the Flare Instument, a New Tool To Identify Flare in Rheumatoid Arthritis (RA) in Clinical Practice. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1752
DOI: 10.1002/art.29517

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