Objective. Evaluation of a psoriatic arthritis (PsA), multidimensional, patient-completed disease flare questionnaire (FLARE). Methods. The FLARE questionnaire was administered to 139 patients in a prospective observational study. The “gold standard” of flare was based on patient opinion. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC). Disease activity was measured by the Psoriatic Arthritis Disease Activity Score (PASDAS), Group for Research and Assessment of Psoriasis and PsA (GRAPPA) Composite Exercise (GRACE), Composite Psoriatic Disease Activity Index (CPDAI), and Disease Activity Index for Psoriatic Arthritis (DAPSA). Results. The most common symptoms of a PsA flare were musculoskeletal, followed by fatigue, frustration, loss of function, and an increase in cutaneous symptoms. The test-retest ICC for the FLARE questionnaire was 0.87 (95% CI 0.72-0.94). The optimum cut-off to identify a flare of disease was 4/10 (sensitivity 0.82, specificity 0.76; area under the curve 0.85). For those patients scoring ≥ 4, the mean score for the composite measures was as follows (score for those not reporting a flare in parentheses): PASDAS 5.3 ± 1.3 (3.1 ± 1.6); GRACE 4.5 ± 1.2 (2.2 ± 1.4); CPDAI 8.9 ± 2.5 (4.7 ± 3.1); and DAPSA 38.2 ± 20.3 (16.8 ± 14.9). In a new flare, the increase in composite measure score was calculated as follows: 1 for PASDAS and GRACE, 2 for CPDAI, and 7 for DAPSA. Agreement between the definition of flare using the cut-off of 4 from the questionnaire, and that indicated by the subject in a separate, standalone question was 0.57 (Cohen κ). Conclusion. A PsA flare displays escalation of symptoms and signs across multiple domains. The FLARE questionnaire has external validity in terms of both composite disease activity and overall patient opinion about the state of their condition.

Original languageEnglish
Pages (from-to)1268-1271
Number of pages4
JournalThe Journal of Rheumatology
Issue number8
Early online date15 Feb 2021
Publication statusPublished - 1 Aug 2021

Bibliographical note

Funding Information:
This report is independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (Early detection to improve outcome in patients with undiagnosed PsA [PROMPT], RP-PG-1212-20007). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. 1P.S. Helliwell, Professor of Clinical Rheumatology, MA, DM, PhD, R. Waxman, Research Coordinator, MPH, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2W. Tillett, Consultant Rheumatologist, MBChB, PhD, Department of Pharmacy and Pharmacology, University of Bath, and Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK; 3L.C. Coates, NIHR Clinician Scientist and Associate Professor, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; 4M. Brooke, Patient Partner; 5O. FitzGerald, Consultant Rheumatologist, MD, Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; 6J.C. Packham, Consultant Rheumatologist, BM, FRCP, DM, Division of Epidemiology and Public of Health, University of Nottingham, Nottingham, UK; 7N. McHugh, Professor of Rheumatology, MBChB, MD, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. The authors declare no conflicts of interest relating to this manuscript. Address correspondence to Dr. P.S. Helliwell, LIRMM, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. Email: p.helliwell@leeds.ac.uk. Accepted for publication February 2, 2021.

Publisher Copyright:
© 2021 The Journal of Rheumatology


  • Outcome measures
  • Psoriasis
  • Psoriatic arthritis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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