Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, and Medication Change
| Autor: | Christine Iannaccone, Vivian P. Bykerk, Nancy A. Shadick, Clifton O. Bingham, Michelle Frits, Michael E. Weinblatt, Taysir G Mahmoud, Jie Huang |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Immunology Pain Logistic regression Severity of Illness Index law.invention Medication change Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Rheumatology law Adrenal Cortex Hormones Surveys and Questionnaires medicine Immunology and Allergy Severe pain Humans 030212 general & internal medicine Patient Reported Outcome Measures Prospective Studies Registries skin and connective tissue diseases Aged 030203 arthritis & rheumatology Clinical consultation Biological Products business.industry Middle Aged medicine.disease Symptom Flare Up Home based Clinical trial Cross-Sectional Studies Treatment Outcome Rheumatoid arthritis Antirheumatic Agents Physical therapy Disease Progression Female business Flare Boston |
| Zdroj: | The Journal of rheumatology. 47(3) |
| ISSN: | 0315-162X |
| Popis: | Objective.Describe strategies used to manage rheumatoid arthritis (RA) flares that contribute to a successful postflare outcome.Methods.Data were collected from the BRASS registry, including clinical and patient-reported outcomes, and a survey with a Likert scale assessing postflare symptoms (better, unchanged, or worse). A logistic regression analysis adjusting for age, sex, flare number in the past 6 months, flare pain severity, home management, clinical consultation, and medication change was performed to evaluate factors influencing flare outcome.Results.Of 503 participants, 185 reported at least 1 flare that had resolved in the past 6 months, with median (interquartile range) 28-joint count Disease Activity Score based on C-reactive protein 3 score 2.1 (1.7–2.8). Compared with RA symptoms before the flare, 22 (12%) patients felt worse, 125 (68%) were unchanged, and 38 (20%) felt better. To manage flares, 72% of patients used home-based remedies, 23% sought clinical consultation, and 56% made medication change. Of 103 patients who changed medication, 70% did so without seeking clinical advice. Making a medication change (OR 3.48, 95% CI 1.68–7.21) and having lower flare pain (OR 0.83, 95% CI 0.71–0.97) were associated with better flare outcome.Conclusion.Flares occur frequently even in patients with low disease activity. Independent of home-based or clinically guided care, making a medication change and having less severe pain during a flare were associated with better flare outcomes. Of interest, the decision to change medications was frequently made without clinical advice. Future studies might address how best to intervene when patients experience flares and whether patient-initiated medication changes have adverse outcomes. |
| Databáze: | OpenAIRE |
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