Background RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. Methods People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. Results DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. Conclusion Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.

中文翻译：

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早期类风湿关节炎初始队列中的疾病活动发作和疼痛发作；特征、前因和后遗症。

背景 RA 耀斑是常见的并且是致残的。它们被描述为炎症恶化，但疼痛和炎症通常是不一致的。为了告知治疗决策，我们调查了炎症和疼痛发作是否是离散的实体。方法 来自早期 RA 网络 (ERAN) 队列的人在就诊后的 11 年内每年进行一次评估（n = 719，3703 人年的随访）。耀斑事件以两种并行分析的不同方式定义；DAS28 或疼痛发作。DAS28 耀斑满足 OMERACT 耀斑标准，即自上次评估以来 DAS28 增加（如果活动性 RA ≥1.2 分，如果非活动性 RA ≥ 0.6 分）。SF36-身体疼痛评分的 ≥ 4.8 分恶化定义为疼痛发作。分析了每个人的第一次记录的 DAS28 和疼痛发作的发作。使用潜在类别分析确定 DAS28 和疼痛发作中的亚组。比较发作亚组之间的临床过程。结果 DAS28 (45%) 和 Pain Flare (52%) 很常见，但通常不一致，60% 的 DAS28 Flare 参与者不同时出现 Pain Flare，64% 的 Pain Flare 参与者不同时出现 DAS28 Flare。确定了三个离散的 DAS28 Flare 亚组。一个的特点是关节触痛/肿胀数量增加（14.4%），第二个是症状增加（13.1%），第三个表现出较低的耀斑严重程度（72.5%）。确定了两个离散的疼痛发作亚组。一个发生在疾病活动和症状低（88.6%）之后，另一个发生在持续的活动性疾病和疼痛的背景下（11.4%）。尽管观察到 DAS28 和疼痛发作之间存在差异，每一种都与在耀斑发作之后持续存在的残疾增加有关。结论 RA 患者的发作既常见又异质。此外，我们的研究结果表明，对于某些患者来说，在突发事件中炎症和疼痛之间存在不一致。这种离散的耀斑亚组可能反映了不同的潜在炎症和疼痛机制。可能需要针对不同机制的治疗来减少 DAS28 和疼痛发作后的持续性残疾。这种离散的耀斑亚组可能反映了不同的潜在炎症和疼痛机制。可能需要针对不同机制的治疗来减少 DAS28 和疼痛发作后的持续性残疾。这种离散的耀斑亚组可能反映了不同的潜在炎症和疼痛机制。可能需要针对不同机制的治疗来减少 DAS28 和疼痛发作后的持续性残疾。