International journal of rheumatic diseases · 2026
Clinical Characteristics and Management for Flares in Patients With Rheumatoid Arthritis Treated With Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs.
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Kim Young-Eun, Ahn Soo Min, Oh Ji Seon, Kim Yong-Gil, Lee Chang-Keun, Yoo Bin, Hong Seokchan
Аннотация
OBJECTIVE: 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).
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.