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Background: Previous research has neither addressed how RA patients’ symptoms change daily, nor how this relates to their selfreported flare status. Aims: (i) to identify whether any symptoms were related to patients’ self-reports of flare; and (ii) to see whether a prodrome of flare can be identified. Methods: RA patients completed self-reported VAS (0–10) of pain, fatigue, swollen joints, stiffness, anger, frustration and worry and flare status (yes/no) daily for 3 months either on paper or online. Patients were also asked daily: Is your RA in a flare condition today? Finally, patients were asked weekly whether they had sought medical help. This was an exploratory study and therefore not powered for statistical significance. Data were analysed for descriptive statistics and visually analysed with the use of graphs to identify symptom patterns. These data were also compared with the data from 15 qualitative interviews that had previously been conducted in which RA patients discussed their experiences of flares. Results: 28 patients agreed to take part: 5 withdrew, 6 had missing data for >10/91 days. The 17 patients included in the analysis were 15 female, mean age: 62.9 years, disease duration: 18.6 years, HAQ: 1.86. Three patients reported constant flare for 91 days (constant flare group), 6 patients selfreported 1 flare with periods of non-flare (intermittent flare group) and 8 patients did not report being in a flare (daily life group)In the daily life group, patients’ individual mean pain scores ranged from 0.2 to 5.8, whereas in the intermittent flare group patients’ individual mean pain scores ranged from 2.5 to 7.0 and in the constant flare group patients’ individual mean pain scores ranged from 2.4 to 9.3. Thus some individual patients reported lower mean pain in flare than other patients reported on non-flare days, this was also the case with the other self-reported measures (see Table 1). Further 5/6 patients in the intermittent flare group rated their symptoms as more severe on non-flare days than on days in flare. Thus patients may be using different criteria other than symptoms to decide whether they are in flare. Whilst many patients reported traditional inflammatory flare of symptoms, other patients may be reporting flare based on experiencing overall loss of control in their lives and thus defining their overall disease activity as more severe (in flare) despite individual symptoms being less severe. The term avalanche flare is proposed for this cascading effect of life. This idea was supported by the qualitative interview data. Conclusion: Definitions of flare vary within and between patients and may not be defined by symptom severity alone. Clinicians need to be aware that patients use flare to explain a range of experiences. Understanding the terminology is necessary to improve communication and inform treatment decisions. Disclosure statement: The author has declared no conflicts of interest.

I19. Life as Fluctuating Balance: Flare Tipping Points, Inflammatory and Avalanche Flares