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.
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.
J Rheumatol. 2017 Dec;44(12):1920-1927. doi: 10.3899/jrheum.161107. Epub 2017 Jul 1.
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 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.
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.
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.
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.
在描述骨关节炎（OA）发作时，除了加剧疼痛外，患者和医疗保健专业人员还会添加其他值得充分阐明的元素，例如积液、肿胀和活动受限。为了定义和概念化 OA 中的“发作”这一概念，目的是确定恶化的关键变量或症状，并阐明患者和临床医生在文献中如何描述这些变量。
对 Medline 和 PsychINFO 中的文献进行了系统回顾。简而言之，使用的搜索词是“骨关节炎”、“膝关节”、“髋关节”和“发作”。确定了纳入研究的具体特征，包括研究设计类型、评估的发作类型、发作如何发展以及使用的发作定义，包括定义是否基于定性或定量分析。
在这些研究中，疼痛是发作定义的主要因素。确定了发作的四个组成部分：疼痛、其他因素、综合标准和整体评估。虽然大多数研究报告使用标准化结局测量标准，将发作定义为疼痛增加，但只有 1 项研究使用定性方法报告了疼痛发作的前因后果。
在风湿病试验中使用发作作为结局或纳入标准是很常见的；然而，本综述强调了目前使用的 OA 发作定义的广泛差异，以及对疼痛测量的重视。这种定义上的差异不允许在试验之间进行直接比较，并限制了对证据的解释。
