Validation and predictive capacity of a Dutch version of the FLARE-RA questionnaire within the context of a TNFi-tapering trial

Doumen, Michaël; Bertrand, Delphine; Pazmino, Sofia; Cock, Diederik De; Stouten, Veerle; Wergifosse, Isabelle de; Moeyersoons, Anneleen; Westhovens, René; Verschueren, Patrick

doi:10.1007/s10067-022-06320-x

Cited by 2 publications

(1 citation statement)

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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%