The American English version of the validated French Flare Assessment in RA Questionnaire (FLARE-RA)

Barroso, Nashla; Woodworth, Thasia; Fürst, Daniel E.; Guillemin, Françis; Fautrel, Bruno; Borazan, Nabeel; Kafaja, Suzanne; Brook, Jenny; Elashoff, D.; Ranganath, V

doi:10.1007/s10067-019-04755-3

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Importantly, while using pure patient reporting as definition of flare may not be ideal (see concept of T2T), our aim was to use a patient-based anchor, but to then map it to objective scales that are also proposed for T2T. Definitions of flares that are solely based on patient reports have been proposed previously,29–33 but have not yet reached use in clinical trials or as monitoring tools. In fact, various studies underlined the importance of swollen joint counts, which are associated with longer-term structural progression; similarly, this is true for acute phase reactants 34–36…”

Section: Discussionmentioning

confidence: 99%

Definition of rheumatoid arthritis flare based on SDAI and CDAI

Konzett,

Kerschbaumer,

Smolen

et al. 2023

Ann Rheum Dis

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ObjectiveTo develop and validate definitions for disease flares in rheumatoid arthritis (RA) based on the quantitative Simplified and Clinical Disease Activity Indices (SDAI, CDAI).MethodsWe analysed RA treatment courses from the Norwegian disease-modifying antirheumatic drug registry (NOR-DMARD) and the Vienna RA cohort. In a receiver operating curve analysis, we determined flare definitions for absolute changes in SDAI and CDAI based on a semiquantitative patient anchor. NOR-DMARD was sampled into an 80%-training cohort for cut point derivation and a 20%-test cohort for internal validation. The definitions were then externally validated in the independent Vienna RA cohort and tested regarding their performance on longitudinal, content, face, and construct validity.ResultsWe analysed 4256 treatment courses from NOR-DMARD and 2557 from the Vienna RA cohort. The preliminary definitions for absolute changes in SDAI and CDAI for flare are an increase of 4.7 and 4.5, respectively. The definitions performed well in the test and external validation cohorts, and showed clinical face and construct validity, as flares significantly impact both functional (∆Health Assessment Questionnaire flare vs no-flare +0.43; p<0.001) and structural (∆modified Sharp Score 43% higher after flare; p<0.001) disease outcomes, and reflect consistent worsening across all disease core sets, both patient reported and objective.ConclusionWe here provide novel definitions for flare in RA based on SDAI and CDAI, validated in two large independent real-world cohorts. In times of highly effective medications for RA, and consideration of their tapering, these definitions will be useful for guiding decision making in clinical practice and designing clinical trials.

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Section: Discussionmentioning

confidence: 99%

Definition of rheumatoid arthritis flare based on SDAI and CDAI

Konzett,

Kerschbaumer,

Smolen

et al. 2023

Ann Rheum Dis

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“…The overall FLARE-RA score is the mean of the 11 items, with a range from 0 (no flare) to 10 (maximum flare). This questionnaire has been cross-culturally adapted and validated in different languages including French, English, Spanish, Danish and Italian [12][13][14][15][16][17]. Disease activity is routinely assessed at the time of the clinic visits, but this tool aims to detect patients with fluctuating disease activity outside of consultations, the capture of such information being a key component in an adequate therapeutic decision-making.…”

Section: Introductionmentioning

confidence: 99%

Cut-off value to identify a flare using the Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire: analysis of the TOSCA study

Aouad

Gaudin²,

Vittecoq³

et al. 2021

Rheumatology

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Objective The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) self-administered questionnaire aims to identify patients who had flare in the interval between 2 consultations. This study aimed to establish a threshold for FLARE-RA score to identify RA flare. Methods The Tocilizumab SubCutAneous (TOSCA) study evaluated the efficacy and safety of subcutaneous Tocilizumab (TCZ) to patients with active RA. Disease activity was assessed with the DAS28ESR at baseline and at week 2 (W2), W4, W12, and W24. The FLARE-RA questionnaire was administered at W12 and W24. Patient satisfaction, assessed at baseline and W24 with the Patient Acceptable Symptom State (PASS), was used as a surrogate marker of no flare. A correlation was sought between the FLARE-RA score at W12 and W24 and the area under the receiver operating characteristic (ROC) curve (AUC) for monthly DAS28ESR. The optimal FLARE-RA cut-off below which patient satisfaction reached the PASS was explored with an ROC curve. Results 139 patients were included (mean age 57.3 ± 13.8 years, 74.1% women, mean RA duration 10.8 ± 9.2 years, mean DAS28ESR 5.8 ± 1.1). The correlation between the FLARE-RA score and DAS28ESR AUC was moderate at all times: rho = 0.41 at W12 (p<0.0001) and 0.51 at W24 (p<0.0001). The optimal cut-off for the FLARE-RA score to identify absence of flare (i.e. an acceptable situation based on the PASS) was 2.3 with an AUC of 0.81. Conclusion FLARE-RA and DAS28ESR assessment differ; we propose a FLARE-RA cut-off of 2.3, below which the situation (i.e. without flare) is acceptable for patients.

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