Clinical Rheumatology

, Volume 38, Issue 11, pp 3025–3032 | Cite as

Optimization of flare management in patients with rheumatoid arthritis: results of a randomized controlled trial

  • Elena MyasoedovaEmail author
  • Cynthia S. Crowson
  • Rachel E. Giblon
  • Kathleen McCarthy-Fruin
  • Daniel E. Schaffer
  • Kerry Wright
  • Eric L. Matteson
  • John M. DavisIII
Original Article



To evaluate the effect of a flare management intervention guided by non-physician providers versus usual care between rheumatology visits on flare occurrence and rheumatoid arthritis (RA) disease activity.


Adult patients with established RA (per 2010 ACR criteria, n = 150) were randomized to the intervention arm (n = 75) versus usual care (n = 75). The Flare Assessment in Rheumatoid Arthritis (FLARE-RA) questionnaire was administered monthly during 24 months to all patients in the intervention arm to assess flare status. Telephone nurse-led counseling or an expedited visit with a rheumatology provider was offered to patients in the intervention arm who indicated they were in flare.


Patients in the intervention arm completed a median of 8.5 (range 1–24) questionnaires. RA flare was reported on 122 (19%) of these questionnaires; average FLARE-RA score, 4.72 on 0 (no flare) to 10 (maximum flare) scale. Patients preferred an expedited clinic visit with a rheumatology provider during 39 (32%) of flares. The majority of patients preferred to self-manage their flare (76, 62%); some patients received nursing advice on flare management over the phone (7, 6%). There were no differences in RA flare by OMERACT9 definition, DAS28-CRP, CDAI, SDAI, anti-rheumatic treatment change by rheumatology provider, or remission by CDAI between the study arms over 24-month follow-up.


The flare management intervention did not have any major effect on flare occurrence or RA disease activity metrics over the 24-month follow-up. The majority of patients in the intervention arm preferred self-management to an expedited visit with their rheumatology provider.

Trial registration Identifier: NCT02382783 (

Key Points

The flare management intervention had no effect on rheumatoid arthritis (RA) disease activity.

Patients preferred self-management of their RA flares to expedited rheumatology provider visits.


Flare Randomized controlled trial Rheumatoid arthritis 



This work was financially supported by a grant from Pfizer (Grant ID 15322005).

Compliance with ethical standards

The study was approved by the Institutional Review Board of Mayo Clinic and was registered at the Identifier: NCT02382783 ( All patients included in the study signed a written informed consent for participation in this study.


Elena Myasoedova: no disclosures or COI

Cynthia S. Crowson: no disclosures or COI

Rachel E. Giblon: no disclosures or COI

Kathleen McCarthy-Fruin: no disclosures or COI

Daniel E. Schaffer: no disclosures or COI

Kerry Wright: no disclosures or COI

Eric L. Matteson: Grant/Research/Clinical Trial Support (rheumatoid arthritis)

Genentech, Mesoblast, Novartis, Pfizer, Sun Pharmaceutical Industries, Ltd

Editorial functions: UpToDate

John M. Davis, III: Grant/Research/Clinical Trial Support (rheumatoid arthritis) Pfizer


Funders reviewed the protocol for the study but had no role in study conduct or interpretation of the results.


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Elena Myasoedova
    • 1
    Email author
  • Cynthia S. Crowson
    • 1
    • 2
  • Rachel E. Giblon
    • 2
  • Kathleen McCarthy-Fruin
    • 1
  • Daniel E. Schaffer
    • 1
  • Kerry Wright
    • 1
  • Eric L. Matteson
    • 1
  • John M. DavisIII
    • 1
  1. 1.Division of Rheumatology, Department of Internal MedicineMayo Clinic College of Medicine and ScienceRochesterUSA
  2. 2.Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo ClinicRochesterUSA

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