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New Review Defines “Naturally Occurring” Acute Flares in Knee OA

Osteoarthritis flares are most often used in the context of drug withdrawal or flare design trials

A PPM Brief

In a new review,1 researchers sought to identify and synthesize definitions of acute flares in knee osteoarthritis (OA) as reported in the medical literature. Despite there not currently being a consensus on a single, agreed definition of “naturally occurring” flares in knee OA, the authors hypothesized that domains taken from acute events in other chronic conditions, such as lupus and ankylosing spondylitis, would be relevant and provide a basis for doing so. Having a foundation could lead to more useful research and clinical applications, they wrote.1

“From a clinical perspective, a unified definition of a flare could enable clinicians to provide prompt, rationalized and focused treatment,” they wrote. “This could also have implications for delivery of self-management strategies involving patients and how episodic management is advocated by clinical guidelines.”

The researchers searched original articles and conference abstracts to extract data such as definition; pain scale used; flare duration or withdrawal period; associated symptoms; definition rationale; terminology (eg, exacerbation or flare); baseline OA severity, age, gender; sample size; and study design. Ultimately, 69 papers were included in their review (46 flare design trials, 17 observational studies, and 6 other designs).

“Naturally occurring” acute flares were determined using the following domains taken from acute events in other chronic conditions: worsening of signs and symptoms (found in 61 studies using 27 different measurement tools), specifically increased pain intensity; minimum pain threshold at baseline (found in 44 studies); minimum duration (found in 7 studies, ranging from 8 to 48 hours); speed of onset (in 2 studies, defined as “sudden” or “quick”); and requirement for increased medication (found in 2 studies).1  The researchers, however, reported finding “considerable variation in how these domains have been operationalized for measurement,” thereby suggesting the need for further conceptual clarification and consensus.1

The authors concluded that the “cardinal feature” of knee OA flares is pain intensity, “with minimum symptom threshold being another important feature,” and encouraged the need to gain consensus on a common definition.

Last updated on: August 23, 2018
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