A recent prospective study published in Joint Bone Spine has provided important findings into the clinical utility of the self-reported Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire in early rheumatoid arthritis (RA). The investigators found that while the FLARE-RA global score was significantly associated with physician-based disease activity measures and treatment intensification, it was not associated with radiographic structural damage progression at 24 months.
The FLARE-RA questionnaire was developed and validated by the Strategy of Treatment in Patients with Rheumatoid Arthritis (STPR) working group to identify RA flares occurring within the three months preceding a clinical visit. Designed as a self-administered patient-reported outcome measure, it captures disease fluctuations between scheduled rheumatology assessments. The 11-item instrument integrates domains identified by both patients and physicians, including joint swelling, joint pain, night waking, and analgesic use, as well as patient-reported aspects such as fatigue, reduced ability to perform activities, need for assistance, social withdrawal, low mood, and irritability. Physician-specific elements include morning stiffness, daily corticosteroid dose, and patient global assessment. This multidimensional structure enables a comprehensive assessment of flare experiences outside the clinic setting.
The prospective observational study enrolled adults with RA of less than 10 years’ duration and a Health Assessment Questionnaire Disability Index (HAQ-DI) score below 1. Participants were followed clinically every six months and completed the FLARE-RA questionnaire at home every three months over a 24-month period. Wrist and foot radiographs were obtained at baseline and at month 24. Statistical analyses included logistic regression and generalized linear mixed-effects models to examine associations between FLARE-RA scores, structural outcomes, and disease activity parameters.
Among the 221 patients analyzed, the median age was 58 years (interquartile range [IQR] 48.0–66.0), and 67.4% were female. The median time from RA diagnosis was 1.4 years (IQR 0.5–2.8), reflecting an early RA cohort. At study entry, 84.6% of patients were receiving ongoing RA therapy, and 46% were in remission according to the 28-joint Disease Activity Score (DAS28). Over the 24-month follow-up, the FLARE-RA global score was not associated with structural changes (odds ratio [OR] 1.00; 95% CI 0.99–1.01) or erosion progression (OR 1.00; 95% CI 0.99–1.01). These findings indicate that higher patient-reported flare scores did not predict radiographic progression within the study timeframe.
In contrast, the FLARE-RA global score demonstrated strong and statistically significant associations with multiple established clinical measures, including DAS28, Physician Global Assessment, HAQ-DI, Patient Acceptable Symptom State, Minimal Clinically Important Difference, and treatment intensification during follow-up (all P<0.0001). Higher flare scores were linked to greater disease activity and a higher likelihood of therapeutic escalation, underscoring the instrument’s responsiveness to clinically meaningful changes.
For medical experts, these results reinforce the value of FLARE-RA as a reliable patient-reported measure of disease activity rather than a predictor of structural joint damage. In routine practice, particularly within tele-rheumatology or hybrid care models, FLARE-RA may support earlier detection of disease worsening and facilitate timely treatment adjustment. While radiographic monitoring remains essential for assessing structural outcomes, structured patient-reported tools such as FLARE-RA can complement treat-to-target strategies by enhancing inter-visit disease surveillance and informed clinical decision-making.
Reference
Fautrel B, Bialé L, Couderc M, Basch A, Gandjbakhch F, Guillemin F. Association between rheumatoid arthritis flares and joint structural changes at 24 months: using FLARE-RA questionnaire. Joint Bone Spine. 2026 Jan;93(1):105957.