• E van Mulligen, WeelA E A MAEAMDepartment of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands., T M Kuijper, HazesJ M WJMWDepartment of Rheumatology, Erasmus MC, Rotterdam, the Netherlands., van der Helm-van MilA H MAHMDepartment of Rheumatology, Erasmus MC, Rotterdam, the Netherlands; Department of Rheumatology, LUMC, Leiden, the Netherlands., and de JongP H PPHPDepartment of Rheumatology, Erasmus MC, Rotterdam, the Netherlands..
• Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands. Electronic address: elise.vanmulligen@erasmusmc.nl.
• Semin. Arthritis Rheum. 2020 Jun 1; 50 (3): 423-431.

ObjectivesTo determine the impact of a disease flare on patient reported outcome measures (PROMs) in rheumatoid arthritis (RA) patients, who are tapering treatment.MethodsData were used from the TARA trial; a multicenter, randomized controlled trial in which RA patients, with a well-controlled disease (DAS≤2.4 and SJC≤1) for at least 6 months, gradually tapered their DMARDs. PROMs of patients with a flare (DAS>2.4 and/or SJC>1) were compared every three months before and after a flare with their own norm values. Linear Mixed Models were used to investigate whether a disease flare influenced functional ability (HAQ-DI), fatigue (BRAF-MDQ), quality of life (EQ-5D and SF36), anxiety and depression (HADS), morning stiffness, general health (GH) and worker productivity, and if so, the duration was determined. For unemployment and sick leave we used descriptive statistics.ResultsA flare negatively influenced GH, morning stiffness, HAQ-DI, EQ-5D, BRAF-MDQ, and the SF36 physical component scale and this effect lasted >3 months. Except for the HAQ-DI, effect sizes exceeded the minimum clinically important differences (MCIDs). For the physical outcomes effects lasted >6 months. Worker productivity was not significantly affected by a flare.ConclusionA disease flare influenced patients' lives, the largest effect was seen in the physical outcomes, and lasted 6 months. Although on a group level effect sizes for the separate PROMs were not always significant or larger than specific MCIDs, a disease flare can still be of great importance for individual patients.Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.

24 keywords...

hide…