Self-reported flares are predictors of radiographic progression in rheumatoid arthritis patients in 28-joint disease activity score remission: a 24-month observational studyReport as inadecuate

Self-reported flares are predictors of radiographic progression in rheumatoid arthritis patients in 28-joint disease activity score remission: a 24-month observational study - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 18:89

First Online: 14 April 2016Received: 09 January 2016Accepted: 31 March 2016


BackgroundDisease flares are common in rheumatoid arthritis RA and are related to structural damage. However, few data on the impact of flares reported by patients on radiographic progression are available. Our aim was to investigate whether overall flares OF, self-reported flares SRF and short flares assessed at the visit SF predict radiographic progression in RA patients in DAS28 28-joint disease activity score remission.

MethodsWe reviewed the records of RA patients included in our database. We considered all patients who had a period of at least 24 months in remission DAS28 < 2.6, stable biologic and synthetic disease-modifying anti-rheumatic drug treatment, no missing follow-up visits and hands and feet radiographs at the start and at the end of the 24-month follow up. Radiographic progression was considered as an increase in the van der Heijde modified total Sharp score >0. Patients were assessed every 3 months and flares were recorded. We defined SRF as any worsening of the disease reported by patients occurring in the time between visits and SF as an increase in DAS28 ≥ 2.6 or >0.6 from the previous visit assessed by the physician in one isolated visit. The impact of SRF, SF and OF on radiographic progression was assessed through multivariate regression analysis.

ResultsOne hundred forty-nine patients were included. The median number interquartile range of OF was 1.00-year 0.50; 1.38, of SRF was 0.50-year 0.14; 1.00, and of SF was 0.34-year 0; 0.50. Eighteen patients 12.1 % experienced a progression of radiographic damage. OF and SRF were significant predictors of radiographic progression: OR 3.27, 95 % CI 1.30, 8.22 and OR 3.63, 95 % CI 1.16, 11.36, respectively.

ConclusionsOF and SRF are predictors of structural damage. Flares assessed at the visit, SF, do not impact on radiographic progression as they might underestimate the actual number of flares.

KeywordsFlares Self-reported flares Rheumatoid arthritis DAS28 remission Radiographic progression Biologic treatment AbbreviationsADAadalimumab

CIconfidence interval

CRPC-reactive protein


DASdisease activity score

DAS2828-joint disease activity score

DMARDdisease-modifying anti-rheumatic drug

HAQHealth Assessment Questionnaire

IQRinterquartile range



OFoverall flares

ORodds ratio


RArheumatoid arthritis

SDstandard deviation

SFshort flares

SRFself-reported flares

TSSvan der Heijde modified total Sharp score

VASvisual analog scale

VIFvariance inflation factor

Electronic supplementary materialThe online version of this article doi:10.1186-s13075-016-0986-1 contains supplementary material, which is available to authorized users.

An erratum to this article can be found at

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Author: Francesca Ometto - Bernd Raffeiner - Livio Bernardi - Costantino Botsios - Nicola Veronese - Leonardo Punzi - Andrea Doria


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