Endorsement of the domains of knee and hip osteoarthritis (OA) flare: A report from the OMERACT 2020 inaugural virtual consensus vote from the flares in OA working group

King, Lauren; Epstein, Jonathan; Cross, Marita; Buzzi, Marie; Buttel, Thomas; Cembalo, Sam Michel; Spitz, Élisabeth; Adams, Cameron Louis; Adebajo, Adewale; Bennell, Kim L; Blanco, Boris; Uhunmwangho, Courage; Décary, Simon; Gill, M John; Gill, Tiffany K.; Hajji, Raouf; Hinman, Rana S; Jones, Allyson; Li, Linda; Mather, Kate; Mani, Ramakrishnan; Nasef, Samah Ismail; Oo, Win Min; Østerås, Nina; Otobo, Tarimobo M.; Ramiro, Sofía; Sharma, Saurab; April, Karine Toupin; Touma, Zahi; Whittaker, Jackie L.; Wluka, Anita E.; Grosskleg, Shawna; Hunter, David J.; Shea, Beverly; Hawker, Gillian; Callahan, Leigh F.; March, Lyn; Guillemin, Françis

doi:10.1016/j.semarthrit.2021.03.010

Cited by 19 publications

(5 citation statements)

References 12 publications

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“…The most frequent symptoms of knee OA are activity-related knee pain (95% sensitivity; 19% specificity) and/or functional limitations (56% sensitivity; 63% specificity), usually accompanied by brief (<30 minutes) morning stiffness (88% sensitivity; 52% specificity), swelling (43% sensitivity; 41% specificity), and buckling or giving way (26% sensitivity; 79% specificity) . Symptoms usually start gradually during a prolonged history of discomfort interspersed with self-limited flare-ups . The cardinal signs of knee OA on physical examination include crepitus (89% sensitivity; 60% specificity), bony enlargement (55% sensitivity; 95% specificity), and restricted range of motion (17% sensitivity; 96% specificity) …”

Section: Osteoarthritismentioning

confidence: 99%

Evaluation and Treatment of Knee Pain

Duong,

Oo,

Ding

et al. 2023

JAMA

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ImportanceApproximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain.ObservationsKnee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching).Conclusions and RelevanceKnee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.

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Section: Osteoarthritismentioning

confidence: 99%

Evaluation and Treatment of Knee Pain

Duong,

Oo,

Ding

et al. 2023

JAMA

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“…More recently, the Outcome Measures in Rheumatology (OMERACT) flares in osteoarthritis working group identified pain, stiffness, swelling, psychological aspects (including low mood and irritability), and impact as the five domains which characterise a pain flare in both hip osteoarthritis and KOA [56]. In addition, Traore et al (2022) [54] from this working group developed FLARE-OA, a new 19-item self-reported questionnaire to assess the occurrence and the severity of flares in both knee and hip osteoarthritis [54].…”

Section: Assessment Of Pain Flaresmentioning

confidence: 99%

Assessment of Pain in Osteoarthritis of the Knee

Thirumaran

Deveza

Atukorala

et al. 2023

JPM

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Knee osteoarthritis (KOA) pain is a subjective and personal experience, making it challenging to characterise patients’ experiences and assess their pain. In addition, there is no global standard for the assessment of pain in KOA. Therefore, this article examines the possible methods of assessing and characterising pain in patients with KOA using clinical symptoms, pain assessment tools, and imaging. We examine the current methods of assessment of pain in KOA and their application in clinical practice and clinical trials. Furthermore, we explore the possibility of creating individualised pain management plans to focus on different pain characteristics. With better evaluation and standardisation of pain assessment in these patients, it is hoped that patients would benefit from improved quality of life. At the same time, improvement in pain assessment would enable better data collection regarding symptom response in clinical trials for the treatment of osteoarthritis.

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“…Flare definitions for use in widespread clinical practice remain untested, as defining flares is a relatively new concept. One working definition is: “a transient state, different from the usual state of the condition, with a duration of a few days, characterised by onset, worsening of pain, swelling, stiffness, impact on sleep, activity, functioning, and psychological aspects that can resolve spontaneously or lead to a need to adjust therapy.”10 Achieved through international consensus, and endorsed by people living with osteoarthritis as part of the Outcome Measures in Rheumatology Flares in Knee and Hip Osteoarthritis Working Group, this definition is primarily used for research purposes 101112. The 2022 UK NICE osteoarthritis guidelines define flares similarly, further specifying duration where episodes lead to a change in therapy for ≥24 hours 2.…”

Section: What Are Osteoarthritis Flares?mentioning

confidence: 99%

Recognising and managing osteoarthritis flares in primary care

Parry,

Walker,

Thomas

2023

BMJ

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Endorsement of the domains of knee and hip osteoarthritis (OA) flare: A report from the OMERACT 2020 inaugural virtual consensus vote from the flares in OA working group

Cited by 19 publications

References 12 publications

Evaluation and Treatment of Knee Pain

Evaluation and Treatment of Knee Pain

Assessment of Pain in Osteoarthritis of the Knee

Recognising and managing osteoarthritis flares in primary care

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