Flare Prediction: Do You Know Ahead of Time?

Do you know a week, two weeks, or a few days ahead of a flare that you are going to have one? Do you get that dreaded feeling of, "Oh no...something is about to happen"? Do you start cutting back on activity because this one feels like it might last awhile?

How I predict an RA flare

I know I get that feeling and usually, I am correct. Here comes a flare and I am going to be sidelined for a bit.  Of course, my feelings are not 100 percent accurate. Sometimes I get that feeling when I know I have to do something I dread, and I am like, "Oh wow, here comes a flare." Then the event passes and what I thought was a flare was actually an acute dislike of the event which feels much like a flare, but with a shorter-term downside.  Unless it is visiting those special relatives.

Conversations with my rheumatologist

My rheumatologist always says to call him when I feel this way and we can talk about upping my NSAID dose for a few days to get you through. But you know I hate doing that if the flare is actually a personal thing instead of a real flare.  I can hear the conversation:

Rick: I am feeling like I am going to have a flare

Doctor: How severe do you think it is?

Rick: Well, it depends if my cousin will be at the picnic. You know we have never gotten along.

Doctor: Hey Rick, let's leave the NSAID where it is. Here is a number for your therapist. You know we are a treatment team.

I really like my rheumatologist, but he might get a little upset with repeated false warnings or referrals from the other part of my treatment team.

PRIME cells and RA flare prediction

Discounting my little melodramas, there is some research that indicates that scientists have found a type of cell that could be used up to a week in advance to predict a flare. These newly discovered cells have been termed prime cells.

They have been shown to accumulate in the blood of people who are having a flare. This has led to speculation that a blood test might be developed to predict a flare up to a week in advance. This study first reported in the New England Journal of Medicine in July and is titled "RNA Identification of PRIME Cells Predicting Rheumatoid Arthritis Flares." It could lead to new understandings of what constitutes flares, their pre-activity duration, or even triggers, using these cells as keys to unlock the mystery of what causes flares. It could also lead to an understanding of the duration of the flare build-up and what agents, if any, can interrupt the flare process.

The research showed that individuals who were studied had enhanced prime cell activity for up to two weeks preceding a flare.¹ Further, as the flare progressed, prime cell activity (as well as the presence of beta cells) decreased.¹

An at-home diagnostic tool

One other thing was reported by this study. The data was collected using finger sticks at home.¹ While the reading device was not disclosed, it is amazing that participants could obtain the required blood sample from a small finger stick. This reminds me of the early home measurement of glucose, using a small finger stick. Home measurements of blood components that may predict a flare have incredible potential to improve the lives of people with rheumatoid arthritis.

The impact of this research

There is a popular saying about what is important. It goes something like, "If you are not measuring, it is not important." This discovery could give our doctors a way to measure flares, making flares less a by-product of RA and more a mainstream focus which, of course, says nothing about my cousin. Now if we really were serious about preventing flares, we would focus our study on how to keep him away.