Skip to main content

Advertisement

Log in

Patient self-assessment of flare in rheumatoid arthritis: criterion and concurrent validity of the Flare instrument

  • Brief Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The French Flare instrument (FI) aims to identify flares in rheumatoid arthritis between consultation. The objective of the present study was to present both concurrent and criterion validity of the Danish version of FI, as compared to DAS28-CRP. The study was a cross-sectional study comparing FI with DAS28-CRP among patients with rheumatoid arthritis (RA) in connection with the same outpatient visit. The study population consisted of 117 prevalent patients diagnosed with RA according to the ACR 1987/2010 criteria. Consecutive patients were included in the study in relation to their outpatient treatment at the Department of Rheumatology, Aarhus University Hospital, Denmark between 01 October 2012 and 31 December 2012. The sensitivity and specificity were 85.4 (95 % CI, 72.2; 93.9) and 50.7 (95 % CI, 38.4; 63.0), respectively. The positive predictive value was 53.6 (95 %CI, 47.0; 60.1) and the negative predictive value 83.9 (95 % CI, 71.7; 91.5). Positive and negative likelihood ratio were 1.73(95 % CI, 1.33; 2.26) and 0.29 (95 % CI, 0.14; 0.59). Tests with high sensitivity and small LR are most useful for ruling out the disease. Hence, our findings indicate that FI works well in ruling out a flare among patients with RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Berthelot JM, De Bandt M, Morel J et al (2012) A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: the ‘FLARE’ instrument. Ann Rheum Dis 71:1110–1116

    Article  PubMed  Google Scholar 

  2. Department of Health (2010) Equity and excellence, Liberating the NHS. 2010 PROM data. Available at http://www.england.nhs.uk/statistics/statistical-work-areas/proms/

  3. Dougados M, Aletaha D, van Riel P (2007) Disease activity measures for rheumatoid arthritis. Clin Exp Rheumatol 25:S22–9

    CAS  PubMed  Google Scholar 

  4. Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19:539–549

    Article  PubMed Central  PubMed  Google Scholar 

  5. Felson DT, Anderson JJ, Boers M et al (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum 36:729–740

    Article  CAS  PubMed  Google Scholar 

  6. Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    Article  CAS  PubMed  Google Scholar 

  7. Bruce B, Fries JF (2003) The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol 30:167–178

    PubMed  Google Scholar 

  8. Yildirim K, Karatay S, Melikoglu MA, Gureser G, Ugur M, Senel K (2004) Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 34:423–426

    PubMed  Google Scholar 

  9. Kushner I (1991) C-reactive protein in rheumatology. Arthritis Rheum 34:1065–1068

    Article  CAS  PubMed  Google Scholar 

  10. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  11. Deeks JJ, Altman DG (2004) Diagnostic tests 4: likelihood ratios. BMJ 329:168–169

    Article  PubMed Central  PubMed  Google Scholar 

  12. Lie E, Woodworth TG, Christensen R et al (2014) Validation of OMERACT preliminary rheumatoid arthritis flare domains in the NOR-DMARD study. Ann Rheum Dis 73:1781–1787

    Article  PubMed  Google Scholar 

  13. Smolen JS, Aletaha D, Bijlsma JW et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637

    Article  PubMed Central  PubMed  Google Scholar 

  14. Aletaha D, Nell VP, Stamm T et al (2005) Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 7:R796–806

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Fleischmann R, van der Heijde D, Koenig AS et al (2014) How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index? Ann Rheum Dis 0:1–6

    Google Scholar 

  16. Kirwan JR, Ahlmen M, de Wit M et al (2005) Progress since OMERACT 6 on including patient perspective in rheumatoid arthritis outcome assessment. J Rheumatol 32:2246–2249

    PubMed  Google Scholar 

Download references

Acknowledgments

We highly appreciate the collaboration with Professor Bruno Fautrel, Department of Rheumatology, Pitié-Salpétriêre Hospital, Paris Cedex, France, who allowed us to translate the FI questionnaire from French into Danish and to carry out the first reliability and validity study. Financial support was provided by the Clinical Institute of Medicine, Aarhus University

Disclosures

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annette de Thurah.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Thurah, A., Maribo, T. & Stengaard-Pedersen, K. Patient self-assessment of flare in rheumatoid arthritis: criterion and concurrent validity of the Flare instrument. Clin Rheumatol 35, 467–471 (2016). https://doi.org/10.1007/s10067-014-2849-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-014-2849-y

Keywords

Navigation