Abstract
BackgroundWhile knee osteoarthritis (OA) is characterised as a slowly progressive disease, acute flares, episodes of severe pain, and substantial fluctuations in pain intensity appear to be part of the natural history for some patients. We sought to estimate what proportion of symptomatic community-dwelling adults might be affected, and to identify patient and problem characteristics associated with higher risk of such variability in pain.MethodsWe analysed data collected at baseline, 18, 36, 54, and 72 month follow-up of a prospective cohort of symptomatic adults aged over 50 years with current/recent knee pain. At each time point we estimated the proportion of participants reporting 'significant pain variability' (defined as worst pain intensity in the past 6 months ≥5/10 and ≥2 points higher than average pain intensity during the same 6-month period). The associations between significant pain variability and demographic, socioeconomic, lifestyle, clinical, radiographic, and healthcare utilisation factors measured at baseline were estimated by adjusted odds ratios and 95% confidence intervals (aOR; 95%CI) from multivariable discrete-time survival analysis.ResultsSeven hundred and nineteen participants were included in the final analysis. At each time point, 23–32% of participants were classed as reporting significant pain variability. Associated factors included: younger age (aOR (per year): 0.96; 95% CI 0.94, 0.97), higher BMI (per kg/m2:1.03; 1.01, 1.06), higher WOMAC Pain score (per unit: 1.06; 1.03, 1.10), longer time since onset (e.g. 1–5 years vs < 1 year: 1.79; 1.16, 2.75) and morning stiffness (≤30 min vs none: 1.43; 1.10, 1.85). The models accounting for multiple periods of significant symptom variability found similar associations.ConclusionsOur findings are consistent with studies showing that, for some patients OA symptoms are significantly variable over time. Future prospective studies on the nature and frequency of flare ups are needed to help determine triggers and their underlying pathophysiology in order to suggest new avenues for effective episode management of OA to complement long-term behaviour change.
Highlights
While knee osteoarthritis (OA) is characterised as a slowly progressive disease, acute flares, episodes of severe pain, and substantial fluctuations in pain intensity appear to be part of the natural history for some patients
There was no strong evidence of selective loss to followup related to presence of significant pain variability at baseline (Additional file 1 Table S1)
Factors associated with time to first period of significant pain variability Based on the outcome of time to first period of significant symptom variability, baseline measures associated with a higher risk of symptom variability in the adjusted analysis were: younger age (OR: 0.96; 95% CI 0.94, 0.97), higher Body mass index (BMI), higher Western Ontario & McMaster Universities Osteoarthritis index (WOMAC) knee pain scores, longer time since onset
Summary
While knee osteoarthritis (OA) is characterised as a slowly progressive disease, acute flares, episodes of severe pain, and substantial fluctuations in pain intensity appear to be part of the natural history for some patients. Longitudinal studies of knee osteoarthritis (OA) with repeated measurements over 5-6 years have suggested that symptoms typically follow relatively stable long-term trajectories [1,2,3,4,5] These can mask considerable within-person variability [6,7,8]. The ‘natural occurrence’ of such flares has received less attention there is a growing body of observational research on these phenomena under a variety of labels (“flares”, “acute events”, “episodes”, “exacerbations”) These include studies that have attempted to define an osteoarthritis flare [11, 12], to understand the role of inflammation in these acute events [13, 14], to identify triggers [15] and to describe their impact on productivity [16]
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