Parry, E, Ogollah, R and Peat, G ORCID: https://orcid.org/0000-0002-9008-0184 (2019) ‘Acute Flare-Ups’ In Patients With, Or At High Risk Of, Knee Osteoarthritis: A Daily Diary Study With Case-Crossover Analysis. Osteoarthritis and Cartilage.

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Abstract

Objective
To determine the natural history of flare-ups in knee osteoarthritis and their relation to physical exposures.

Design
Adults aged ≥45 years with a recent primary care consultation for knee OA/arthralgia completed a daily pen-and-paper diary for up to 3 months, including questions on average knee pain intensity, pain descriptors, other symptoms, activity interference, and selected physical exposures (prolonged kneeling, squatting, climbing stairs, ladders, and moving/lifting heavy objects). Informed by a systematic review, flare-ups were defined a priori. We calculated the rate of flare-ups in the sample, described their nature and duration, and estimated their association with physical exposures in the prior 48 hours.

Results
67 participants completed at least one month of diaries,37 (55%) were female, mean age 62 years (SD 10.6) with a mean body mass index of 24.6 kg/m2 (SD 5.1). 30 participants experienced a total of 54 flare-ups (incidence density 1.09 flare-ups/person-days). The median duration of flare-ups was 8 days (range: 2-30). During a flare-up participants were more likely to report sharp, throbbing, stabbing, burning pain, swelling, limping, stiffness, being woken by pain, taking more analgesia, and stopping usual activities. Exposure to one or more physical exposure increased the risk of a flare-up in the subsequent 48 hours (odds ratio 2.19 (95%CI: 1.22, 4.05)).

Conclusions
Our study with intensive longitudinal data collection suggests acute flare-ups may be experienced by a substantial number of patients. These episodes often last a week or longer, are disruptive, prompt changes in self-management, and may be triggered by high-loading physical activities.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.joca.2019.04.003 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: knee, osteoarthritis, flare-up
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 15 Apr 2019 10:10
Last Modified: 15 Apr 2019 10:12
URI: http://eprints.keele.ac.uk/id/eprint/6188

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