SPCR GP Progression Fellow, Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, UK.
Primary Care Centre Versus Arthritis, Research Institute for Primary Care & Health Sciences, Keele University, UK; Medical Statistics and Clinical Trials, Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, D Floor, South Block, QMC, Nottingham, NG7 2UH, UK.
Osteoarthritis Cartilage. 2019 Aug;27(8):1124-1128. doi: 10.1016/j.joca.2019.04.003. Epub 2019 Apr 14.
To determine the natural history of flare-ups in knee osteoarthritis and their relation to physical exposures.
Adults aged ≥45 years with a recent primary care consultation for knee OA/arthralgia completed a daily pen-and-paper diary for up to three months, including questions on average knee pain intensity, pain descriptors, other symptoms, activity interference, and selected physical exposures (prolonged kneeling, squatting, climbing stairs, ladders, and moving/lifting heavy objects). Informed by a systematic review, flare-ups were defined a priori. We calculated the rate of flare-ups in the sample, described their nature and duration, and estimated their association with physical exposures in the prior 48 h.
67 participants completed at least one month of diaries, 37 (55%) were female, mean age 62 years (SD 10.6) with a mean body mass index of 24.6 kg/m (SD 5.1). 30 participants experienced a total of 54 flare-ups (incidence density 1.12 (95%CI 0.80, 1.57) flare-ups/person-days). The median duration of flare-ups was eight days (range: 2-30). During a flare-up participants were more likely to report sharp, throbbing, stabbing, burning pain, swelling, limping, stiffness, being woken by pain, taking more analgesia, and stopping usual activities. Exposure to one or more physical exposure increased the risk of a flare-up in the subsequent 48 h (odds ratio 2.19 (95%CI: 1.22, 4.05)).
Our study with intensive longitudinal data collection suggests acute flare-ups may be experienced by a substantial number of patients. These episodes often last a week or longer, are disruptive, prompt changes in self-management, and may be triggered by high-loading physical activities.
确定膝骨关节炎发作的自然病程及其与身体暴露的关系。
最近因膝骨关节炎/关节痛在初级保健就诊的年龄≥45 岁成年人完成了长达三个月的每日纸笔日记，包括平均膝关节疼痛强度、疼痛描述符、其他症状、活动干扰以及选定的身体暴露（长时间跪地、下蹲、爬楼梯、梯子和移动/举起重物）的问题。根据系统评价，预先定义了发作。我们计算了样本中的发作率，描述了它们的性质和持续时间，并估计了它们与前 48 小时内身体暴露的关系。
67 名参与者完成了至少一个月的日记，37 名（55%）为女性，平均年龄 62 岁（标准差 10.6），平均体重指数为 24.6kg/m（标准差 5.1）。30 名参与者共经历了 54 次发作（发生率密度 1.12（95%CI 0.80，1.57）发作/人-天）。发作的中位数持续时间为 8 天（范围：2-30）。在发作期间，参与者更有可能报告锐痛、悸动、刺痛、灼热痛、肿胀、跛行、僵硬、被疼痛唤醒、服用更多止痛药和停止日常活动。在接下来的 48 小时内，接触一种或多种身体暴露会增加发作的风险（比值比 2.19（95%CI：1.22，4.05））。
我们的研究采用了密集的纵向数据收集，表明大量患者可能会经历急性发作。这些发作通常持续一周或更长时间，会造成干扰，促使自我管理发生变化，并且可能由高负荷的体力活动引发。
