It's not just the joints, it's the whole thing: qualitative analysis of patients' experience of flare in psoriatic arthritis.

Objective: Flare is a commonly used term in arthritis, including PsA, but remains undefined. This study seeks to explore patients' experience of flare.

Methods: Eighteen semi-structured interviews were undertaken with patients with PsA in an informal clinical setting. Patients were purposively sampled from specialist clinic lists to reflect the major elements of the psoriatic disease spectrum. Approximately one-third of patients reported themselves to be in a flare state at the time of the interview. Transcripts underwent thematic analysis according to the recommendations of Braun and Clarke (Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101). NVivo software was utilized, with initial coding reflecting the source data, such as pain, feeling miserable and feeling slowed down. Codes were then grouped into associated clusters. These clusters and the interrelationships were then summarized into emergent themes.

Results: The mean age of the patients was 44 years, and patients' average disease duration was 4.5 years. Nine main overarching themes pertaining to flare were identified: physical symptoms, social withdrawal, psychological symptoms, fatigue, loss of normal function, triggers, management of pre-flare, management of flare and timing. These show some degree of overlap and are interlinked, with some degree of temporality emerging as related to patients' experience of flare.

Conclusion: This study has identified a number of components of flare in PsA from the patient perspective. Although the emergent themes are of an overlapping and interactive nature, it is clear that flare in PsA is more than a swollen or tender joint count as measured in clinical practice.