G.L. Maica, BA, C. Iannaccone, MPH, V. Feathers, MS, M.L. Frits, BA, M. Weinblatt, MD, N.A. Shadick, MD, MPH, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts.
V.P. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery, New York, New York.
J Rheumatol. 2023 Jul;50(7):889-894. doi: 10.3899/jrheum.211409. Epub 2023 Feb 1.
Recently, there has been consensus on domains that constitute flares in rheumatoid arthritis (RA); however, variations in patients' flare descriptions continue to be observed. This study evaluates how demographic and clinical characteristics influence these differences.
Participants enrolled in a prospective RA registry completed a qualitative survey that included the open-ended question "What does a flare mean to you?" Responses were categorized into Outcome Measures in Rheumatology (OMERACT) core and research domains. Univariate analyses evaluated demographic and clinical characteristics. Regression analyses determined independent variables associated with flare description variations.
Among 645 participants, the median Disease Activity Score in 28 joints (DAS28) with C-reactive protein was 2.1 (IQR 1.6-2.9); 58% of the participants reported at least 1 flare in the past 6 months. Participants reported a median of 3 (IQR 2-5) OMERACT domains when describing flares. Fatigue was more commonly noted among females (odds ratio [OR] 6.12; < 0.001). Older participants were less likely to report emotional distress (OR 0.97; = 0.03), swollen joints (OR 0.99; = 0.04), physical function decrease (OR 0.98; = 0.02), and a general increase in RA symptoms (OR 0.98; = 0.005). Participants with a higher DAS28 score were less likely to report symptoms of stiffness (OR 0.70; = 0.009), and those who experienced a flare within the last 6 months were more likely to describe flares as pain (OR 2.53; < 0.001) and fatigue (OR 2.00; = 0.007).
Variations in patients' flare descriptions can be driven by a patient's disease activity, the experience of a recent flare, as well as different demographic characteristics, such as age and gender. Understanding the interplay of these characteristics can guide a physician's approach to the management of patients' RA flares.
最近，人们对类风湿关节炎（RA）发作的构成领域已经达成共识；然而，仍观察到患者发作描述存在差异。本研究评估了人口统计学和临床特征如何影响这些差异。
参加前瞻性 RA 登记的参与者完成了一项定性调查，其中包括开放式问题“发作对你意味着什么？”应答被归入风湿病结局测量（OMERACT）核心和研究领域。单变量分析评估了人口统计学和临床特征。回归分析确定了与发作描述变化相关的独立变量。
在 645 名参与者中，C 反应蛋白的 28 个关节疾病活动评分（DAS28）中位数为 2.1（IQR 1.6-2.9）；58%的参与者报告在过去 6 个月中至少有 1 次发作。参与者在描述发作时报告中位数为 3（IQR 2-5）个 OMERACT 领域。女性更常报告疲劳（比值比[OR] 6.12；<0.001）。年龄较大的参与者不太可能报告情绪困扰（OR 0.97；=0.03）、关节肿胀（OR 0.99；=0.04）、身体功能下降（OR 0.98；=0.02）和 RA 症状普遍增加（OR 0.98；=0.005）。DAS28 评分较高的参与者不太可能报告僵硬症状（OR 0.70；=0.009），而在过去 6 个月内经历过发作的参与者更有可能将发作描述为疼痛（OR 2.53；<0.001）和疲劳（OR 2.00；=0.007）。
患者发作描述的差异可能由患者的疾病活动度、最近发作的经历以及不同的人口统计学特征（如年龄和性别）驱动。了解这些特征的相互作用可以指导医生对患者 RA 发作的管理方法。
