Questionnaire may aid rheumatoid arthritis flare diagnosis

By Lynda Williams

French researchers have created a 13-item patient-administered questionnaire for identifying a recent or present rheumatoid arthritis (RA) flare.

The Flare Assessment in Rheumatoid Arthritis (FLARE) questionnaire is designed to detect a transient or persistent increase in RA disease activity, explain Jean-Marie Berthelot (Centre Hospitalo-Universitaire de Nantes) and co-authors.

While it has yet to be validated, the researchers say the final FLARE questionnaire "should be suitable for clinical research and might be for daily clinical practice."

As reported in the Annals of the Rheumatic Diseases, the team collated information from interviews with 99 RA patients and a Delphi exercise conducted with a panel of 13 rheumatologists.

The patients reported that a flare usually begins with joint swelling or frozen joints, alongside a significant increase in pain, and an increase in analgesic use. Patients also reported depression, sleep disturbance, fatigue, and an impact on daily activities, including loss of independence, withdrawal, and irritability.

These were combined with seven clinical domains agreed by the rheumatologists to mark flare, including joint pain change, joint swelling, night awakening from pain, increased analgesic and steroid use, morning stiffness, and a patient global assessment of arthritis.

An eighth domain, alternation in C-reactive protein level or erythrocyte sedimentation rate, was not used due to the self-report nature of the questionnaire, say Berthelot et al.

Noting that a threshold level of disease exacerbation for diagnosis of flare has yet to be defined, the researchers emphasize the questionnaire must be tested in a prospective patient trial, to confirm its internal and external validity, and to test its reliability and responsiveness to change.

The feasibility of using the questionnaire in daily practice and its predictive power must also be determined, they add.

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