Clinical Characteristics and Management for Flares in Patients With Rheumatoid Arthritis Treated With Biologic and...

To evaluate the frequency and management of flares in rheumatoid arthritis (RA) patients treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).

Data were analyzed from the KOrean nationwide BIOlogics (KOBIO) registry, which includes RA patients initiating b/tsDMARDs therapy. Flares were defined as an increase in DAS28 (> 1.2, or > 0.6 if DAS28 ≥ 3.2) requiring medication changes. Patients were stratified by flare occurrence, and predictive factors and management strategies were assessed.

Of the 2745 RA patients, 386 (14.1%) experienced flares over a median follow-up period of 5.4 years (IQR, 1.7-11.4). Flares were associated with a significantly higher incidence of shoulder swelling compared with non-flare patients (14.2% vs. 13.7%, p = 0.01). Predictive factors for flares included a higher swollen joint count (HR: 1.125, p = 0.003) and shoulder swelling (HR: 2.810, p = 0.002). Eight patients switched to an alternative b/tsDMARD during flare episodes, while 168 added or modified conventional synthetic DMARDs (csDMARDs). The remaining 210 patients made no changes to their csDMARD regimen. The 12 month retention rate of b/tsDMARDs did not significantly differ between patients who adjusted their csDMARDs and those who did not (86.7% vs. 82.1%, p = 0.23). However, the mean steroid dose over 12 months was lower in the group that adjusted csDMARDs.

Flares occurred in approximately 14% of RA patients during b/tsDMARD treatment, with baseline joint involvement, particularly shoulder swelling, being a predictor. While the adjustment of csDMARDs was associated with reduced steroid use during flare management, it did not significantly affect b/tsDMARD retention rates.