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Background. The assessment of disease activity in rheumatoid arthritis (RA) still remains a challenge because individual patients have different perceptions and require different needs. Both ends on the spectrum of disease activity, remission and flares, are accompanied withpersonal feelings and experiences. Rheumatologists often use different disease activity scores to assess the disease activity, but these may not be comprehensive enough as clinical signs not always represent how the patient is feeling. This may lead to patients not feeling understood because, they are, for example, experiencing a lot of discomfort and potentially a flare, while their rheumatologist thinks otherwise. In this master’s thesis, we wanted to investigate what patients with RA understand by remission and flares. Methods. In this study, patients with RA were interviewed to obtain their perceptions on remission and flares. The interviews were held based on a semi-structured interview guide. The individual face-to-face interviews were audio recorded and transcribed verbatim. Qualitative data was coded and analyzed on an ongoing basis in order to adjust the interview guide if necessary, while further interviews were being performed. The Qualitative Analysis Guide of Leuven (QUAGOL) was used to perform a thematic analysis and thereby construct concepts in the qualitative data. Results. From the analysis four major themes emerged: ‘What is a flare?’, ‘The impact of a flare’, ‘The New Normal’ and ‘Self-management’. Patients all believed they were able to determine for themselves whether they were experiencing a flare, while the duration of a flare was very variable. Patients frequently perceived that joint pain was the most recurrent complaint and was often accompanied with (morning)stiffness and swollen joints. Some patients also experienced extreme fatigue, even worse than pain, while others did not. They pointed out that these complaints were detrimental for their psychosocial well-being and stated that selfmanagement could be helpful to prevent and cope with a flare. Firstly, remission or disease control was seen as being pain-free. Participants stated they could live with other complaints, but suppression of pain was very important. Secondly ‘normality’ was mentioned frequently. Patients want to live their life as before they got RA and use this as a reference to indicate remission. Conclusion. Patients experienced flares as a worsening of symptoms. This caused social and psychological consequences and a reduced quality of life. They perceived remission mainly as being free of pain and/or normality.

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Background: Obesity and overweight are known risk factors for the development of rheumatic disease. Furthermore, these conditions may negatively impact disease evolution and therapeutic efficacy. Based on earlier research, the cause for these negative effects might be an accumulation of adipokines and pro-inflammatory cytokines in patients with obesity, leading to a chronic inflammatory state of the body. Some studies have evaluated the effects of intentional weight loss on rheumatic joint diseases. A systematic review would provide a more extensive in-depth view on this topic. Methods: We systematically searched in 7 databases (Medline, Embase, CINAHL database by EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) and the Web of Science Core Collection) for relevant articles. Two independent reviewers screened the articles using the predetermined in- and exclusion criteria. Included studies examined patients with chronic i

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Objective. Rheumatoid arthritis (RA) is a chronic, inflammatory auto-immune disease during which flares and remission alternate. This study aimed to investigate rheumatologists' perspectives on flare and remission in RA, as there is no clear definition for these terms. Defining flare and remission is crucial for effective patient management, identifying new therapeutic targets, and better understanding RA's pathophysiology. Methods. Semi-structured interviews were conducted with rheumatologists in Belgium. An interview guide captured their experiences and perspectives on flare and remission in RA. The interviews were verbatim transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL) approach. From the interview data, themes were developed to determine the concept of flare and remission. Results. Ten rheumatologists participated in the interviews. Four themes emerged: Change and Stability of the symptoms and signs, Individuality of the disease, Adaptations needed, and Reaching out to the doctor. Change referred to the change in behavior of the patient and disease activity that accompanies a flare. Stability, on the other hand, represented the little/no disease activity and stable quality of life of the patient that remission would entail. Individuality of the disease signified the individual nature of flare and remission. Every patient is different and to know their patient the rheumatologists emphasized the importance of open communication. They also highlighted the variability in the frequency of flares and the need for therapy to be tailored to individual patients. They stressed the importance of patient education and awareness of their disease, and caution against overestimation of disease severity, pain, and disability. Adaptations needed when a patient is diagnosed with RA included coping and prevention measures. Compliance with therapy, a healthy lifestyle, and avoiding triggers such as stress, joint overload, and smoking were recommended by most rheumatologists to prevent flares and maintain remission. Reaching out to the doctor involved shared decision-making in determining flare and remission, with variations in who determines them. Composite scores, such as DAS28, to measure disease activity were frequently mentioned. Imaging, biochemistry parameters, and clinical examination were used to objectively evaluate a flare or remission. Consultations were provided according to the rheumatologists for disease monitoring and additionally when a flare was suspected, with patients seeking more contact with their doctor during periods of flare. Self-management and therapy changes by the rheumatologist were used to treat flares. Conclusion. While no definitive definitions for flare and remission were established, themes emerged including Change and Stability, Individuality, Adaptation, and Reaching out to the doctor, all of which are important factors according to rheumatologists in defining a flare and remission in patients with RA. This study, combined with a similar study in patients, provides valuable insight towards developing clearer definitions. Further research is needed to arrive at concrete definitions.