Annette de Thurah

Definition and construct validation of clinically relevant cutoffs on the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Elena Myasoedova, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA. Electronic address: myasoedova.elena@mayo.edu.
  • ,
  • Annette De Thurah
  • Marie-Line Erpelding, Department of Clinical Epidemiology, INSERM CIC 1433, University of Lorraine and University Hospital of Nancy, Nancy, Lorraine, France.
  • ,
  • Emilce E Schneeberger, Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
  • ,
  • Thomas Maribo
  • Gustavo Citera, Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
  • ,
  • John M Davis, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
  • ,
  • Eric L Matteson, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
  • ,
  • Cynthia S Crowson, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
  • ,
  • Bruno Fautrel, Academic Department of Urology, Pitié-Salpétrière Hospital, AP-HP, Paris, France; UPMC University Paris 06, Institut Universitaire de Cancérologie, Paris, France.
  • ,
  • Francis Guillemin, CIC 1433 Clinical Epidemiology, Inserm, Nancy, France; University of Lorraine, APEMAC, Nancy, France.

OBJECTIVE: The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was devised for the detection of flares in patients with RA. We aimed to define construct validity and cut-off(s) for the FLARE-RA questionnaire.

METHODS: This cross-sectional study included adult patients with prevalent RA (2010 ACR/EULAR criteria) attending outpatient rheumatology clinics in France (n = 138), Denmark (n = 253), USA (n = 75), and Argentina (n = 105). Flare occurrence over the past 3 months was assessed with the FLARE-RA questionnaire scoring from 0 (no flare) to 10 (maximum flare). The cut-offs for the FLARE-RA score were defined using the following anchor items obtained at the same encounter: (1) Patient report of flare; (2) DAS28-CRP > 3.2; (3) Change of anti-rheumatic treatment, based on the area under the receiver operating characteristic curve (AUC) and distance to (0,1).

RESULTS: Four hundred seventy four patients with RA duration ≥2 years (mean age 58.6 years, 74.9% female) were included in the main analysis. The discrimination for the FLARE-RA cut-offs was acceptable-to-excellent: AUC for the global FLARE-RA score ranged from 0.71 to 0.92. The cut-offs for the FLARE-RA score were lower using "patient report of flare" than DAS28-CRP and "change of anti-rheumatic treatment". Proposed FLARE-RA cut-offs for clinical detection and change of anti-rheumatic treatment are 2 and 5, respectively, for patients with RA duration 2-5 years, and 2 and 3.5, respectively, for patients with RA duration >5 years.

CONCLUSIONS: Proposed FLARE-RA cut-offs have acceptable discriminative capacity across the tested anchor items and are expected to aid in early recognition and timely management of RA flares.

OriginalsprogEngelsk
TidsskriftSeminars in Arthritis and Rheumatism
Vol/bind50
Nummer2
Sider (fra-til)261-265
Antal sider5
ISSN0049-0172
DOI
StatusUdgivet - 2020

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