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Clinical Characteristics and Management for Flares in Patients With Rheumatoid Arthritis Treated With Biologic and
Young-Eun Kim1, Soo Min Ahn1, Ji Seon Oh2
1Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
International Journal of Rheumatic Diseases
|March 30, 2026
Summary
Approximately 14% of rheumatoid arthritis (RA) patients on biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) experienced flares. Adjusting conventional synthetic DMARDs (csDMARDs) during flares lowered steroid use but did not impact b/tsDMARD retention.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) management often involves biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).
- Disease flares are common complications impacting patient outcomes and treatment adherence.
- Understanding flare frequency and management is crucial for optimizing RA therapy.
Purpose of the Study:
- To determine the incidence of flares in RA patients receiving b/tsDMARDs.
- To identify predictors of flares in this patient population.
- To evaluate management strategies for RA flares and their impact on treatment outcomes.
Main Methods:
- Analysis of data from the KOrean nationwide BIOlogics (KOBIO) registry.
- Definition of flares based on DAS28 score increases and medication changes.
- Stratification of patients by flare occurrence, with assessment of predictive factors and management strategies.
Main Results:
- Flares occurred in 14.1% of 2745 RA patients over a median follow-up of 5.4 years.
- Predictive factors for flares included higher swollen joint count and shoulder swelling.
- Adjusting conventional synthetic DMARDs (csDMARDs) during flares reduced steroid use but did not significantly alter b/tsDMARD retention rates.
Conclusions:
- Flares are relatively common in RA patients treated with b/tsDMARDs.
- Baseline joint involvement, especially shoulder swelling, predicts flares.
- Modifying csDMARDs is a viable flare management strategy that may reduce steroid dependence without compromising b/tsDMARD efficacy.
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