The Impact Of Patient-Reported Flares On Radiographic Progression In Rheumatoid Arthritis Patients With Low-Disease Activity: A Prospective Cohort Study Based On The Ambra Trial

Background Flares, potentially disabling and disease worsening even when a patient is in low disease activity, are common features in patients with rheumatoid arthritis (RA) that may escape the routine clinical control. Consequently the current treat-to-target goal to achieve remission or low disease activity fails to take into account the potential of flares to represent the persistence of disease activity. It remains unknown whether patient reported flares can worsen radiographic joint damage. Objectives To investigate whether patient reported flares increase the risk for radiographic progression. Methods From 287 patients included in the AMBRA trial (1), 268 RA patients with low disease activity (DAS28-CRP 0 units) across the three groups were compared and the association between flare phenotype and radiographic progression was analyzed by logistic regression. Results 70% of patients were women, median age [IQR] was 63 years [55;70], 73% were rheumatoid factor positive, 71% anti-CCP positive and all had established RA (median [IQR] 7 years [4;13]). Radiographic progression depicted by ΔTSS, ΔJSN, and ΔE, respectively, was seen in 35%, 8%, and 30% of no-flares group (n=77); 37%, 18%, and 32% of patients with transient flares (n=141) and in 46%, 24%, and 34% of patients with persistent joint complaints (n=50). Only differences in worsening of JSN were statistically significant (P=0.038).The flare phenotype was significantly related to worsening in JSN (Figure 1); OR was 2.55 (95%CI, p) (1-6.52, p=0.051) for the transient flares group and 2.12 (1.15-3.91, p=0.016) for the group with persistent joint complaints compared to patients without flares. Defining clinically relevant progression as ≥ smallest detectable change (SDC) of 4.4 TSS units, 14 (10%) patients in the flares group and 7 (14%) patients with persistent joint complaints progressed, compared to none in the no-flares group. Conclusions RA patients with established low active disease, who report transient flares and persistent joint complaints with tender and swollen joints, have more radiographic damage on JSN compared to no-flares patients. References Primdahl J, et al.: Ann Rheum Dis 2014; 73: 357-364 Disclosure of Interest None declared