Flares may be used as outcomes in trials and studies, but to date there is no agreed consensus on how to define them in people with axial spondyloarthritis.

INTRODUCTION
Spondyloarthritis is an umbrella term for several conditions that share many of the same features and symptoms, including ankylosing spondylitis, psoriatic arthritis and reactive arthritis. Patients can also be classified as having axial or non-axial (peripheral) disease, according to which joints in their body are affected. Axial disease affects the sacroiliac joint (in the back part of the pelvis) causing back pain and stiffness. People with axial spondyloarthritis may suffer from flares of their disease, when the symptoms get much worse. These flares tend to alternate with periods of low disease activity or remission, when a person may feel well.

WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to work out how best to define flares (disease worsening) with a number of commonly used tools for measuring disease activity in people with axial spondyloarthritis.

WHO WAS STUDIED? No real people were used in this study.

HOW WAS THE STUDY CONDUCTED?
This was a systematic literature review, which means that the authors identified all the published evidence on a particular topic and drew it together into one summary. They then performed a second exercise where they used made-up patient cases to see how well experts in axial spondyloarthritis agreed on the definition of a flare. In all, 121 expert doctors looked at 46 patient cases and reported whether each one was in flare or not.

WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The main finding was that there is no real agreement about how to define a flare in axial spondyloarthritis, even between experts in the disease. Typically, most doctors would say that a change of around 3 points on a scale from 0 to 10 is a flare.

ARE THESE FINDINGS NEW?
Yes, this is the first time that anyone has tried to define a flare in axial spondyloarthritis.

WHAT ARE THE LIMITATIONS OF THE STUDY?
One main limitation is that the study did not look at real people with axial spondyloarthritis. Additionally, it did not ask real patients with the disease what they consider to be a flare.

WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
More work is being done in this area to help to define flares better. A second study is underway looking at real life people with axial spondyloarthritis. This will ask them to assess their own disease and flag when they think they are having a flare.

WHAT DOES THIS MEAN FOR ME?
If you have axial spondyloarthritis, these studies might mean that in the future your doctor will be better able to talk to you about flares and how to define them. This may also help to standardise the way you and other people with the disease are treated. If you are concerned about your disease or your symptoms, you should talk to your doctor.

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Date prepared: June 2016

Summary based on research article published on: 4 February 2016

From: Gossec, L. et al. Preliminary definitions of ‘flare’ in axial spondyloarthritis, based on pain, BASDAI and ASDAS-CRP: an ASAS initiative. Ann Rheum Dis 2016;75:991–6. doi:10.1136/annrheumdis-2015-208593 Copyright © 2016 BMJ

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