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

Thomas, M.J.; Rathod-Mistry, T.; Parry, E.L.; Pope, C.; Neogi, T.; Peat, G.

Abstract

OBJECTIVE: To identify proximate causes ('triggers') of flares in adults with, or at risk of, knee osteoarthritis (OA), estimate their course and consequences, and determine higher risk individuals. METHODS: In this 13-week web-based case-crossover study adults aged =40 years, with or without a recorded diagnosis of knee OA, and no inflammatory arthropathy who self-reported a knee flare completed a questionnaire capturing information on exposure to 21 putative activity-related, psychosocial and environmental triggers (hazard period, =72 hours prior). Comparisons were made with identical exposure measurements at four 4-weekly scheduled time points (non-flare control period) using conditional logistic regression. Flare was defined as a sudden onset of worsening signs and symptoms, sustained for =24 hours. Flare characteristics, course and consequence were analysed descriptively. Associations between flare frequency and baseline characteristics were estimated using Poisson regression. RESULTS: Of 744 recruited participants (mean age (SD) 62.1 (10.2) years; 61% female), 376 reported 568 flares (hazards) and provided 867 valid control period measurements. Thirteen exposures (8 activity-related, 5 psychosocial/environmental) were positively associated with flare onset within 24 hours (strongest odds ratio estimate, knee buckling: 9.06: 95% confidence interval [CI] 5.86, 13.99; weakest, cold/damp weather: 1.45: 95%CI 1.12, 1.87). Median flare duration was 5 days (IQR 3, 8), less common if older (incident rate ratio [IRR] 0.98: 95%CI 0.97, 0.99), more common if female (IRR 1.85: 95%CI 1.43, 2.39). CONCLUSIONS: Multiple activity-related, psychosocial and environmental exposures are implicated in triggering flares. This evidence can help inform prevention and acute symptom management for patients and clinicians.

Citation

Thomas, M., Rathod-Mistry, T., Parry, E., Pope, C., Neogi, T., & Peat, G. (2021). Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults. Osteoarthritis and Cartilage, 29(7), 956-964. https://doi.org/10.1016/j.joca.2021.04.007

• Journal Article Type: Article
• Acceptance Date: Apr 19, 2021
• Online Publication Date: Apr 29, 2021
• Publication Date: Jul 1, 2021
• Publicly Available Date: May 30, 2023
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 7
• Pages: 956-964
• DOI: https://doi.org/10.1016/j.joca.2021.04.007
• Keywords: Knee; Osteoarthritis; Flare; Web-based; Case-crossover
• Publisher URL: https://doi.org/10.1016/j.joca.2021.04.007