Marita Cross1,2, Ludovic Dubouis3,4, Matthieu Mangin3,4, David J Hunter3,4, Lyn March3,4, Gillian Hawker3,4, Francis Guillemin3,4. 1. From the Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia; Inserm, CIC 1433 Clinical Epidemiology; University of Lorraine, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. maritac@med.usyd.edu.au. 2. M. Cross, Research Fellow, PhD, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; L. Dubouis, Medical Resident, Inserm, CIC 1433 Clinical Epidemiology; M. Mangin, Medical Resident, Inserm, CIC 1433 Clinical Epidemiology; D.J. Hunter, PhD, Professor of Medicine, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; L. March, PhD, FRACP, FAFPHM, Professor of Rheumatology and Musculoskeletal Epidemiology, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; G. Hawker, MD, PhD, Chair and Professor of Medicine, Department of Medicine, University of Toronto; F. Guillemin, MD, PhD, Professor of Epidemiology and Public Health, Inserm, CIC 1433 Clinical Epidemiology, and University of Lorraine, EA 4360 APEMAC. maritac@med.usyd.edu.au. 3. From the Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia; Inserm, CIC 1433 Clinical Epidemiology; University of Lorraine, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. M. Cross, Research Fellow, PhD, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; L. Dubouis, Medical Resident, Inserm, CIC 1433 Clinical Epidemiology; M. Mangin, Medical Resident, Inserm, CIC 1433 Clinical Epidemiology; D.J. Hunter, PhD, Professor of Medicine, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; L. March, PhD, FRACP, FAFPHM, Professor of Rheumatology and Musculoskeletal Epidemiology, Institute of Bone and Joint Research-Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital; G. Hawker, MD, PhD, Chair and Professor of Medicine, Department of Medicine, University of Toronto; F. Guillemin, MD, PhD, Professor of Epidemiology and Public Health, Inserm, CIC 1433 Clinical Epidemiology, and University of Lorraine, EA 4360 APEMAC.
Abstract
OBJECTIVE: Beyond the exacerbation of pain in describing a flare in osteoarthritis (OA), patients and health professionals add other elements that deserve to be fully elucidated, such as effusion, swelling, and mobility limitation. To define and conceptualize the construct flare in OA, the objective was to identify the key variables, or symptoms, that worsen, and to clarify how these variables are described in the literature by patients and clinicians. METHODS: A systematic review of the literature was conducted in Medline and PsychINFO. In brief, the search terms used were "osteoarthritis," "knee," "hip," and "flare." Specific characteristics of included studies were identified, including the type of study design, type of flare assessed, how the flare developed, and what definition of flare was used, including whether the definition was based on qualitative or quantitative analysis. RESULTS: Pain was the major factor in the definition of flare within these studies. Four components of flare were identified: pain, other factors, composite criteria, and global assessment. While the majority of studies reported flare as an increase in pain using standardized outcome measures, only 1 study reported the antecedents and consequences of a pain flare using qualitative methods. CONCLUSION: The use of flare as an outcome or inclusion criterion in rheumatology trials is a common occurrence; however, this review highlights the wide variation in the definitions of OA flare currently in use and the emphasis on the measurement of pain. This variation in definition does not allow for direct comparison between trials and limits interpretation of evidence.
OBJECTIVE: Beyond the exacerbation of pain in describing a flare in osteoarthritis (OA), patients and health professionals add other elements that deserve to be fully elucidated, such as effusion, swelling, and mobility limitation. To define and conceptualize the construct flare in OA, the objective was to identify the key variables, or symptoms, that worsen, and to clarify how these variables are described in the literature by patients and clinicians. METHODS: A systematic review of the literature was conducted in Medline and PsychINFO. In brief, the search terms used were "osteoarthritis," "knee," "hip," and "flare." Specific characteristics of included studies were identified, including the type of study design, type of flare assessed, how the flare developed, and what definition of flare was used, including whether the definition was based on qualitative or quantitative analysis. RESULTS:Pain was the major factor in the definition of flare within these studies. Four components of flare were identified: pain, other factors, composite criteria, and global assessment. While the majority of studies reported flare as an increase in pain using standardized outcome measures, only 1 study reported the antecedents and consequences of a pain flare using qualitative methods. CONCLUSION: The use of flare as an outcome or inclusion criterion in rheumatology trials is a common occurrence; however, this review highlights the wide variation in the definitions of OA flare currently in use and the emphasis on the measurement of pain. This variation in definition does not allow for direct comparison between trials and limits interpretation of evidence.
Entities:
Keywords:
FLARE; LITERATURE REVIEW; OMERACT; OSTEOARTHRITIS
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