‘Acute flare-ups’ in patients with, or at high risk of, knee osteoarthritis: a daily diary study with case-crossover analysis

Abstract

19Objective: To determine the natural history of flare-ups in knee osteoarthritis and their 20 relation to physical exposures. 21 22 Design: Adults aged ≥45 years with a recent primary care consultation for knee 23 OA/arthralgia completed a daily pen-and-paper diary for up to 3 months, including 24 questions on average knee pain intensity, pain descriptors, other symptoms, activity 25 interference, and selected physical exposures (prolonged kneeling, squatting, climbing 26 stairs, ladders, and moving/lifting heavy objects). Informed by a systematic review, flare-ups 27 were defined a priori. We calculated the rate of flare-ups in the sample, described their 28 nature and duration, and estimated their association with physical exposures in the prior 48 29 hours. 30 31Results: 67 participants completed at least one month of diaries,37 (55%) were female, 32 mean age 62 years (SD 10.6) with a mean body mass index of 24.6 kg/m 2 (SD 5.1). 30 33 participants experienced a total of 54 flare-ups (incidence density 1.09 flare-ups/person-34 days). The median duration of flare-ups was 8 days (range: 2-30). During a flare-up 35 participants were more likely to report sharp, throbbing, stabbing, burning pain, swelling, 36 limping, stiffness, being woken by pain, taking more analgesia, and stopping usual activities. 37 Exposure to one or more physical exposure increased the risk of a flare-up in the 38 subsequent 48 hours (odds ratio 2.19 (95%CI: 1.22, 4.05)). 39 40 Conclusions: Our study with intensive longitudinal data collection suggests acute flare-ups 41 may be experienced by a substantial number of patients. These episodes often last a week 42 108 109 RESULTS 110 111Of the 220 out of 330 responders to the baseline questionnaire, 106 (48%) were eligible and 112 were invited to take part in the diary study, consented to further contact, and were mailed 113 the first diary. Reasons for non-eligibility included; inflammatory disease (41), TKR (27), 114 missing/blank Q (22), no recent knee pain (14), withdrew/died/moved (10). Of the 67 (63%) 115 participants who completed at least one monthly diary, 37 (55%) were female, mean age 62 116 years (SD 10.6) with a mean body mass index of 24.6 kg/m 2 (SD 5.1). Of a possible 5491 117 diary days, 4328 (79%) were fully completed, 1163 (21%) were partially completed, and 111 118 (2%) were missed completely. Comparing responders to non-responders ages were similar 157 158 DISCUSSION 159Our study supports the notion that knee OA, for some people, is characterised by 160 intermittent acute or sudden increases in pain with an associated change in pain quality and 161 knee symptoms. 162 163 Pain intensity in our study was highly variable for some and stable for others. 164 Although not explored in this study, Schneider et al found a link between pain variability in 165 OA and depression 15 . Qualitative studies have highlighted the highly variable nature of pain 166 in OA 2 and when unpredictable can be associated with considerable distress 3 . 167 208 209 All authors were ...

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

“…The direction of our observed associations with exposure to one or more physical activities is consistent with previous study 35 , as is our positive association with knee buckling. 37 More broadly, our observed associations with a range of physical and psychosocial exposures are consistent with previous study of back pain 9 , knee/hip OA 10 , knee OA 11,13 and hip OA 12,38 .…”

“…Previous work by Marty et al 46 showed clearly that patient-identified flares agreed well with clinician-defined flares. The similarity of findings with others 11,13,35,37 also provide some valuable replication and suggest that these associations may not be too highly sensitive to this choice of flare definition. Other signs and symptoms, for example, stiffness, swelling and functional impact may be earlier or more important initial symptoms associated with flare onset.…”

“…It may impact on the ability to perform everyday activities and result in an increase in analgesic intake” 15,p9 . This self-determined definition was derived from our pilot study 16 , previous literature review 34 , discussions with patients and members of the public, and findings from previous survey and daily diary studies 35 . Written explanation and short videos about flares, developed with patients and presented by our patient co-investigator (CP) and clinician-researcher (MJT), were available to view on the ACT-FLARE website for all enrolled and prospective participants for the study duration.…”

Diagnostic accuracy of grayscale, power Doppler and contrast-enhanced ultrasound compared with contrast-enhanced MRI in the visualization of synovitis in knee osteoarthritis

“…This may be explained by a high false-positive rate of detecting effusion on clinical examination, as well as the fact that imaging for this study was not performed at the time of the clinical diagnosis of synovitis. Moreover, OA is characterized by so-called "flare-ups", sudden and temporary increases in symptoms along with exacerbations of synovitis [18,19], and it is possible that the degree of synovitis at the time of imaging was lower than during clinical examination. However, since our analyses focused on comparison of imaging techniques within the same patient exactly at the same time point, we expect that this will not have affected our results.…”

Over-the-counter naproxen in rheumatology practice: scope and therapeutic benefits

“…Е. Parry и соавт. [21] оценивали частоту и продолжительность рецидивов ОА у 67 больных, которые фиксировали обострения заболевания в дневнике. В течение месяца обострение ОА возникло у 30 (45%) больных, причем у 16 из них -лишь одно, у 6 -два, у 6 -три, у 2 -четыре; длительность обострения составляла в среднем 8 дней (от 3 до 30).…”