Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Consensus Among Patients and Health Care Professionals for Essential Domains to Assess Disease Flares in Rheumatoid Arthritis: Results of Final OMERACT Delphi.

Bartlett1,  Susan J., Woodworth2,  Thasia G., Bingham III3,  Clifton O., Alten4,  Rieke, Pohl5,  Christoph, Choy6,  Ernest, Hewlett7,  Sarah

McGill University, Montreal, QC
Bone & Joint Decade, Santa Barbara, CA
Stanford University, Palo Alto, CA
UCLA Medical School, Los Angeles, CA
Copenhagen, Denmark
Leading Edge Clinical Research, Stuart, FL
Johns Hopkins University, Baltimore, MD
Rheumatology Schlossparkklinik, Berlin, Germany
Schlosspark Klinik, Berlin, Germany
Cardiff University, Cardiff, ENGLAND, United Kingdom
University of the West of England, Bristol, United Kingdom
University Hospital Maastricht, Maastricht, Netherlands
Brigham & Women's Hospital, Boston, MA


Although the term "flare" is often used to describe episodes of disease worsening, no established definition currently exists for rheumatoid arthritis (RA). As a result, little is known about the impact of RA flares on treatment outcomes such as function, disability, health-related quality of life and work productivity. The goal of the OMERACT RA Flare Group is to establish a framework to assess RA flares from both patient and health care professional (HCP) perspectives and develop a measurement tool for use in research and clinical settings.


Flare was defined as a worsening of disease activity of sufficient intensity and duration to result in consideration of a change of therapy. Formative research to identify relevant domains included focus groups/surveys with patients, stakeholder interviews and a literature search. An international group of patients and HCPs participated in subsequent rounds of Delphi exercises to rate candidate domains as "essential" or "not essential." Core domains were defined a priori as those with >=70% support from all participants.


Results are from the final Delphi round conducted through December 2010. Participants included 125 patients from 10 countries and 108 HCPs from 23 countries. Patients had a mean (± SD) age of 56 ±12 yrs and disease duration of 18 ± 12 yrs. HCPs included physicians from clinical practice/research (79%) and industry (6%), allied health providers (8%), researchers (6%) and undisclosed (1%), with 17 ± 11 yrs clinical rheumatology experience. Most (>82%) had participated in earlier surveys.

Core domains identified include: Pain (93%), Function (89%), Swollen Joints (84%), Tender Joints (81%), Participation (81%), Stiffness (79%), Patient Global Assessment (76%) and Self-Management (75%); Fatigue (68%) will receive further consideration. Domains which did not reach the level of consensus will continue to be explored separately. The figure below shows the pooled proportions and relative strength of agreement between groups; bubble size reflects estimate precision.


As part of the process to develop a measure, core domains of RA flare were identified by patients and HCPs: Pain, Function, Swollen Joints, Tender Joints, Stiffness, Participation, Patient Global Assessment and Self Management, with Fatigue receiving additional consideration. Next steps include identifying potential items for each domain and conducting studies to validate and refine the measurement tool.

To cite this abstract, please use the following information:
Bartlett, Susan J., Woodworth, Thasia G., Bingham III, Clifton O., Alten, Rieke, Pohl, Christoph, Choy, Ernest, et al; Consensus Among Patients and Health Care Professionals for Essential Domains to Assess Disease Flares in Rheumatoid Arthritis: Results of Final OMERACT Delphi. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :342

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