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. and PEAT, George (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.

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Official URL: https://www.sciencedirect.com/science/article/pii/...
Open Access URL: https://www.sciencedirect.com/science/article/pii/... (Published version)
Link to published version:: https://doi.org/10.1016/j.joca.2021.04.007
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    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 h 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 h. 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 (eight activity-related, five psychosocial/environmental) were positively associated with flare onset within 24 h (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.

    Item Type: Article
    Uncontrolled Keywords: Case-crossover; Flare; Knee; Osteoarthritis; Web-based; Aged; Cross-Over Studies; Exercise; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Sex Factors; Surveys and Questionnaires; Symptom Flare Up; Humans; Osteoarthritis, Knee; Exercise; Cross-Over Studies; Sex Factors; Aged; Middle Aged; Female; Male; Surveys and Questionnaires; Symptom Flare Up; Arthritis & Rheumatology; 0903 Biomedical Engineering; 1103 Clinical Sciences; 1106 Human Movement and Sports Sciences
    Identification Number: https://doi.org/10.1016/j.joca.2021.04.007
    Page Range: 956-964
    SWORD Depositor: Symplectic Elements
    Depositing User: Symplectic Elements
    Date Deposited: 09 Sep 2022 08:59
    Last Modified: 09 Sep 2022 08:59
    URI: http://shura.shu.ac.uk/id/eprint/30527

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