Flares occur frequently in patients with rheumatoid arthritis (RA) with low disease activity and are associated with worse disease activity, quality of life, and radiographic progression, according to a recent study. Furthermore, higher baseline Health Assessment Questionnaire-Disability Index (HAQ-DI) was modestly predictive of flare, while biomarker correlation at the time of flare suggests a non-inflammatory component in a majority of events. Patients with RA who were taking disease-modifying antirheumatic drugs (DMARDs) and had a stable 28-joint count Disease Activity Score (DAS28) <3.2 were eligible for inclusion. Flare was defined as an increase in DAS28 compared with baseline of >1.2, or >0.6 if concurrent DAS28 ≥ 3.2. Researchers found:

• Of 152 patients, 46 (30%) experienced a flare.
• Functional disability at baseline was associated with flare: HAQ-DI had an unadjusted HR 1.82 and EQ-5D had HR 0.20.
• In multivariate analyses, only HAQ-DI remained a significant independent predictor of flare (HR 1.76).
• Two-thirds of flares were not associated with a rise in biomarkers.
• Patients who flared had significantly worse outcomes at 12 months.