Over a decade ago, immunologist Kathy Molnar-Kimber was investigating gene therapy for cancer at the University of Pennsylvania in Philadelphia, but struggled with devastating flares of her rheumatoid arthritis.

“At the time, if you touched my left arm, it hurt so badly that it felt like exploding grenades for hours,” says Molnar-Kimber. 

Biologic response modifiers and corticosteroids did not successfully control her inflammation and flares. So she tried to look “outside the box” to identify self-management strategies and complementary therapies to alleviate her pain. Techniques like praying, regular hydration, herbal treatments and vitamins and avoiding harsh environmental chemicals like insect sprays seemed to lessen the impact or duration of her flares. 

How to Measure a Flare

Flares – acute episodes of various RA symptoms, including pain, inflammation, stiffness, fatigue and impaired physical function – vary in intensity, duration and impact on the ability to perform daily tasks like typing, dressing or driving. Finding better ways to measure flares’ intensity and identify possible triggers are areas that many RA researchers, including Molnar-Kimber, are now exploring.

People with RA may struggle to communicate effectively about their flares to their rheumatologists, making treatment a guessing game. Identifying the potential triggers of flares, as well as ways rheumatologists may better quantify and categorize these episodes, may facilitate more effective communication and treatment, says Thasia Woodworth, MD, a rheumatologist and nephrologist currently researching flares at the University of California, Los Angeles, Medical Center.

While working on a project to develop rheumatic disease toxicity criteria in 1999, Dr. Woodworth and other researchers realized that there was no standard measurement to quantify RA flares. Yet patients often report flares in clinical trials that study drug toxicity and effectiveness. 

“We need to be able to measure reliably, consistently and in a standard fashion all the adverse events and effects in these clinical trials,” says Dr. Woodworth. To understand flares and their impact better, researchers and clinicians alike need reliable measurement tools.

Defining Flares

In 2006, OMERACT’s (Outcome Measures in Rheumatology, an international research organization) Drug Safety Working Group chartered an RA Flare Definition Working Group to develop a standard definition of RA flares. The goal is to create a patient questionnaire to allow rheumatologists to detect, measure and define the intensity of RA flares and, based on the results, suggest proper treatment.