Patient-perceived flares in rheumatoid arthritis: A sub-analysis of the STRASS treatment tapering strategy trial - 10/09/17

Doi : 10.1016/j.jbspin.2016.10.001

Agnès Portier ^a,^b,^c,^h,^⁎ , Laure Gossec ^a,^b,^h, Florence Tubach ^d,^e,^f,^h,^{^{1
CRI-IMIDIATE, Clinical Research Network, France.}}, Toni Alfaiate ^d,^e,^f,^h, Thao Pham ^g,^h, Alain Saraux ^i,^h, Martin Soubrier ^i,^h, Thierry Schaeverbeke ^j,^h, Jean-Francis Maillefert ^k,^h, Xavier Mariette ^l,^h, David Hajage ^d,^e,^f,^h,^{^{1
CRI-IMIDIATE, Clinical Research Network, France.}}, Bruno Fautrel ^a,^b,^h,^{^{1
CRI-IMIDIATE, Clinical Research Network, France.}}
^a Sorbonne Universités, UPMC Université Paris 06, Institut Pierre-Louis d’Épidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), 75013 Paris, France
^b Department of rheumatology, Pitié-Salpêtrière Hospital, AP–HP, 75013 Paris, France
^c Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
^d Département d’Épidémiologie et Recherche clinique, Hôpital Bichat, AP–HP, 75018 Paris, France
^e Inserm, CIC-EC 1425, UMR 1123, ECEVE, 75018 Paris, France
^f Université Paris Diderot, Sorbonne Paris Cité, UMR 1123, 75018 Paris, France
^g Aix-Marseille University, AP–HM, Rheumatology Department, Sainte-Marguerite Hospital, 13006 Marseille, France
^h Brest University, Rheumatology Department, La Cavale-Blanche University Hospital, 29000 Brest, France
ⁱ Rheumatology Department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
^j Victor-Segalen-Bordeaux 2 University, Rheumatology Department, Pellegrin University Hospital, 33000 Bordeaux, France
^k Burgundy University, Rheumatology Department, Dijon University Hospital, 21000 Dijon, France
^l Paris Sud University–Paris 11, AP–HP, Rheumatology Department, Bicêtre Hospital, 94700 Le Kremlin-Bicêtre, France

^⁎Corresponding author. Service de rhumatologie, hôpital La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75013 Paris, France.

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Abstract

Objectives

Patient's and physician's perspective can differ in rheumatoid arthritis (RA). The aim was to define the concept of patient-reported flares.

Methods

Post-hoc analysis of a randomized controlled trial of a step-down strategy in RA patients treated with anti-TNF, in DAS28-remission for ≥6 months, randomized to either “spacing” or “maintaining” anti-TNF. The occurrence of patient-reported flares (PRF) was evaluated every 3 months for 18 months by: “Over the last 3 months, did you experience symptoms suggestive of disease exacerbation?”. Visits with and without PRF were compared, using a linear mixed effects model, in terms of symptoms, disability based on the Health Assessment Questionnaire, quality of life based on Short Form 36 Health Survey and DAS28-based relapses (DBR), defined as an increase of DAS28>0.6 and an absolute value of DAS28>2.6. The agreement between PRF and DBR was measured by the kappa coefficient on repeated data.

Results

In all, 137 patients were analyzed: mean age 55±11 years, females 78%, mean RA duration 9.5±8.0 years. Over the 18 months, PRF concerned 27.2% of the 940 available visits. DBR and PRF were observed in 24% and 16% of 940 visits for 137 patients respectively. All the items were associated with PRF with standardized effect size between −0.58 (SF36 PCS) and 0.87 (DAS28). The agreement between PRF and DBR was moderate (κ=0.44).

Conclusion

The concept of flare refers to more than just RA disease activity.

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Keywords : Rheumatoid arthritis, Flares, TNF-blockers, Pain, Questionnaires

Esquema

Frequency of patient-reported flares

PRF and other signs or symptoms of RA activity

Agreement between PRF and DBR

Discussion

Disclosure of interest

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Vol 84 - N° 5

P. 577-581 - octobre 2017 Regresar al número

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Patient-perceived flares in rheumatoid arthritis: A sub-analysis of the STRASS treatment tapering strategy trial - 10/09/17

Abstract

Objectives

Methods

Results

Conclusion

Esquema

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