From the Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical School, New York, New York; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Touro College of Osteopathic Medicine, New York, New York, USA.
J Rheumatol. 2014 Feb;41(2):227-34. doi: 10.3899/jrheum.121521. Epub 2013 Dec 15.
To describe the frequency, duration, and management of flares as reported by patients with rheumatoid arthritis (RA).
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.
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.
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.
描述类风湿关节炎（RA）患者报告的发作频率、持续时间和管理情况。
从一家学术中心招募的 RA 患者参与了一项前瞻性观察研究，数据由这些患者收集。这些患者根据医生的判断接受治疗。每 6 个月，患者报告 RA 发作的次数和持续时间，并描述他们如何通过添加或改变药物以及使用非药物策略来管理这些发作。
在研究期间至少报告过一次发作的患者中，74%的患者在研究入组前 6 个月报告有发作，59%的患者在首次 6 个月就诊前报告有发作。在随后的就诊中，54-57%的患者报告有>1 次发作。30%的缓解期患者报告有发作。发作持续时间≥2 周的占 30%，1-2 周的占 13%，<1 周的占 57%。40%的患者在发作时报告药物改变；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。发作持续时间较长与改变疾病修饰治疗相关。
当 RA 患者处于较高疾病活动状态时，他们更常经历发作，并且当发作持续时间较长时，他们更频繁地改变疾病修饰抗风湿药物或生物制剂。需要前瞻性地研究与疾病活动相关的发作症状强度和持续时间，并在制定发作衡量标准时考虑自我管理策略。
