The impact of a disease flare during tapering of DMARDs on the lives of rheumatoid arthritis patients.
OBJECTIVES
To determine the impact of a disease flare on patient reported outcome measures (PROMs) in rheumatoid arthritis (RA) patients, who are tapering treatment.


METHODS
Data 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.


RESULTS
A 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.


CONCLUSION
A 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.
['van Mulligen|E|E|', 'Weel|A E A M|AEAM|', 'Kuijper|T M|TM|', 'Hazes|J M W|JMW|', 'van der Helm-van Mil|A H M|AHM|', 'de Jong|P H P|PHP|']
D000368:Aged D018501:Antirheumatic Agents D001172:Arthritis, Rheumatoid D004305:Dose-Response Relationship, Drug D000084862:Drug Tapering D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D000071081:Minimal Clinically Important Difference D000071066:Patient Reported Outcome Measures D000076604:Physical Functional Performance D011788:Quality of Life D000067251:Symptom Flare Up D013997:Time Factors D000079424:Tumor Necrosis Factor Inhibitors
Tapering DMARDs Rheumatoid arthritis Patient reported outcome measures