“Flare” and disease worsening in rheumatoid arthritis: Time for a definition

| LEADING ARTICLE | DEFINING FLARE IN RA 85 Address for correspondence: Clifton O Bingham III, MD, Division of Rheumatology, Johns Hopkins University, 5200 Eastern Avenue, Mason F Lord Center Tower Room 404, Baltimore, MD 21224, USA. Email: clifton.bingham@jhmi.edu It has long been recognized that rheumatoid arthritis (RA), even when well treated, may have periods of exacerbation and improvement. Both patients and their clinicians have called these periods of worsening an RA “flare”. Some of these exacerbations are short-lived, necessitating minimal or no intervention, while others may be of a sufficient severity to require changes in medications that address the symptoms and loss of function that accompany a flare. While this phenomenon is well recognized by both physicians and patients, there are no generally agreed-upon parameters to define disease worsening, to characterize its severity, or to describe its onset and duration. RA patient care has undergone important change in the last two decades, with the ability to diagnose disease earlier, the recognition of early joint damage as leading to disability, and the ensuing advent of effective treatment paradigms often including biological therapies. With the increasingly common use of aggressive and earlier combination disease-modifying antirheumatic drug (DMARD) treatment, the numbers of patients experiencing substantial improvement – either “Flare” and Disease Worsening in Rheumatoid Arthritis: Time for a Definition