ArticleThe Journal of rheumatology2018
Flares in Rheumatoid Arthritis Patients with Low Disease Activity: Predictability and Association with Worse Clinical Outcomes.
Article in The Journal of rheumatology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 citations in OpenAlex.
- Multibiomarker disease activity score: an objective tool for monitoring rheumatoid arthritis? A systematic review and meta-analysis.Rheumatology (Oxford, England) · 2023Pooled it
- Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review.Rheumatology international · 2022Pooled it
- Trial
- Optimization of flare management in patients with rheumatoid arthritis: results of a randomized controlled trial.Clinical rheumatology · 2019Trial
- EULAR-OMERACT consensus-based scoring system for synovitis 10 years later: a validated tool for routine care and clinical trials.RMD open · 2026Review
- UK Medical Cannabis Registry: An Updated Analysis of Inflammatory Arthritis.Clinical medicine insights. Arthritis and musculoskeletal disorders · 2026Article
- Immunomodulatory Nanoparticles Enable Combination Therapies To Enhance Disease Prevention and Flare Control in Rheumatoid Arthritis.ACS central science · 2025Article
- Multimodal Noninvasive Assessment of C-Reactive Protein for Systemic Inflammation in Adults: Cross-Sectional Study.JMIR formative research · 2025Article
- Patient-reported outcomes as early warning signs of flare following drug cessation in rheumatoid arthritis.RMD open · 2025Article
- Flares of Systemic Autoimmune Rheumatic Disease Following Coronavirus Disease 2019 Vaccination: A Narrative Review.Rheumatic diseases clinics of North America · 2025Review
- Biomarkers in the diagnosis, prognosis and management of rheumatoid arthritis: A comprehensive review.Annals of clinical biochemistry · 2025Review
- Noninvasive, Multimodal Inflammatory Biomarker Discovery for Systemic Inflammation (NOVA Study): Protocol for a Cross-Sectional Study.JMIR research protocols · 2024Article
- Article
- Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review.Clinical rheumatology · 2024Article
- Association of COVID-19 Vaccinations With Flares of Systemic Rheumatic Disease: A Case-Crossover Study.Arthritis care & research · 2024Article
- Heterogeneity of treatment responses in rheumatoid arthritis using group based trajectory models: secondary analysis of clinical trial data.BMC rheumatology · 2023Article
- Relevance of circulating Semaphorin 4A for rheumatoid arthritis response to treatment.Scientific reports · 2023Article
- Prevalence and factors associated with flares following COVID-19 mRNA vaccination in patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: a national cohort study.Advances in rheumatology (London, England) · 2023Article
- Tailored therapeutic decision of rheumatoid arthritis using proteomic strategies: how to start and when to stop?Clinical proteomics · 2023Review
- Physical Function of RA patients Tapering Treatment-A Post Hoc Analysis of the Randomized Controlled RETRO Trial.Journal of clinical medicine · 2023Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 3 countries.
Funding
Abstract
objectiveTo investigate predictors of flare in rheumatoid arthritis (RA) patients with low disease activity (LDA) and to evaluate the effect of flare on 12-month clinical outcomes.
methodsPatients with RA who were taking disease-modifying antirheumatic drugs and had a stable 28-joint count Disease Activity Score (DAS28) < 3.2 were eligible for inclusion. At baseline and every 3 months, clinical (DAS28), functional [Health Assessment Questionnaire-Disability Index (HAQ-DI), EQ-5D, Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-F), Medical Outcomes Study Short Form-36 (SF-36)], serum biomarkers [multibiomarker disease activity (MBDA) score, calprotectin, CXCL10], and imaging data were collected. Flare was defined as an increase in DAS28 compared with baseline of > 1.2, or > 0.6 if concurrent DAS28 ≥ 3.2. Cox regression analyses were used to identify baseline predictors of flare. Biomarkers were cross-sectionally correlated at time of flare. Linear regressions were performed to compare clinical outcomes after 1 year.
resultsOf 152 patients, 46 (30%) experienced a flare. Functional disability at baseline was associated with flare: HAQ-DI had an unadjusted HR 1.82 (95% CI 1.20-2.72) and EQ-5D had HR 0.20 (95% CI 0.07-0.57). In multivariate analyses, only HAQ-DI remained a significant independent predictor of flare (HR 1.76, 95% CI 1.05-2.93). At time of flare, DAS28 and its components significantly correlated with MBDA and calprotectin, but correlation coefficients were low at 0.52 and 0.49, respectively. Two-thirds of flares were not associated with a rise in biomarkers. Patients who flared had significantly worse outcomes at 12 months (HAQ-DI, EQ-5D, FACIT-F, SF-36, and radiographic progression).
conclusionFlares occur frequently in RA patients with LDA and are associated with worse disease activity, quality of life, and radiographic progression. Higher baseline HAQ-DI was modestly predictive of flare, while biomarker correlation at the time of flare suggests a noninflammatory component in a majority of events.
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