Defining acute flares in knee osteoarthritis: a systematic review

Emma L Parry, Martin J Thomas, George Peat, Emma L Parry, Martin J Thomas, George Peat

Abstract

Objective: To identify and critically synthesise definitions of acute flares in knee osteoarthritis (OA) reported in the medical literature.

Design: Systematic review and narrative synthesis. We searched Medline, EMBASE, Web of science and six other electronic databases (inception to July 2017) for original articles and conference abstracts reporting a definition of acute flare (or synonym) in humans with knee OA. There were no restrictions by language or study design (apart from iatrogenic-induced flare-ups, eg, injection-induced). Data extraction comprised: definition, pain scale used, flare duration or withdrawal period, associated symptoms, definition rationale, terminology (eg, exacerbation or flare), baseline OA severity, age, gender, sample size and study design.

Results: Sixty-nine articles were included (46 flare design trials, 17 observational studies, 6 other designs; sample sizes: 15-6085). Domains used to define flares included: worsening of signs and symptoms (61 studies, 27 different measurement tools), specifically increased pain intensity; minimum pain threshold at baseline (44 studies); minimum duration (7 studies, range 8-48 hours); speed of onset (2 studies, defined as 'sudden' or 'quick'); requirement for increased medication (2 studies). No definitions included activity interference.

Conclusions: The concept of OA flare appears in the medical literature but most often in the context of flare design trials (pain increases observed after stopping usual treatment). Key domains, used to define acute events in other chronic conditions, appear relevant to OA flare and could provide the basis for consensus on a single, agreed definition of 'naturally occurring' OA flares for research and clinical application.

Prospero registration number: CRD42014010169.

Keywords: flare; knee; osteoarthritis.

Conflict of interest statement

Competing interests: GP received consultancy fees from InFirst and Good Relations.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart.

References

    1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the diagnosis, management and prevention of COPD: GOLD, 2016.
    1. National Institute for Health and Care Excellence (NICE). Chronic obstructive pulmonary disease in over 16s: diagnosis and management (CG101). London: NICE, 2010.
    1. Global Initiative for Asthma. Global strategy for asthma management and prevention: GINA, 2015.
    1. Ruperto N, Hanrahan LM, Alarcón GS, et al. . International consensus for a definition of disease flare in lupus. Lupus 2011;20:453–62. 10.1177/0961203310388445
    1. Stone MA, Pomeroy E, Keat A, et al. . Assessment of the impact of flares in ankylosing spondylitis disease activity using the Flare Illustration. Rheumatology 2008;47:1213–8. 10.1093/rheumatology/ken176
    1. Bingham CO, Alten R, Bartlett SJ, et al. . Identifying preliminary domains to detect and measure rheumatoid arthritis flares: Report of the OMERACT 10 RA Flare Workshop. J Rheumatol 2011;38:1751–8. 10.3899/jrheum.110401
    1. Bykerk VP, Lie E, Bartlett SJ, et al. . Establishing a core domain set to measure rheumatoid arthritis flares: report of the OMERACT 11 RA Flare Workshop. J Rheumatol 2014;41:799–809. 10.3899/jrheum.131252
    1. Bartlett SJ, Hewlett S, Bingham CO, et al. . Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus. Ann Rheum Dis 2012;71:1855–60. 10.1136/annrheumdis-2011-201201
    1. Taylor WJ, Shewchuk R, Saag KG, et al. . Toward a valid definition of gout flare: Results of consensus exercises using delphi methodology and cognitive mapping. Arthritis & Rheumatism 2009;61:535–43. 10.1002/art.24166
    1. Schmitt J, Spuls PI, Thomas KS, et al. . The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol 2014;134:800–7. 10.1016/j.jaci.2014.07.043
    1. Holla JFM, van der Leeden M, Knol DL, et al. . The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort. BMC Musculoskelet Disord 2013;14:296 10.1186/1471-2474-14-296
    1. Collins JE, Katz JN, Dervan EE, et al. . Trajectories and risk profiles of pain in persons with radiographic, symptomatic knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2014;22:622–30. 10.1016/j.joca.2014.03.009
    1. Leffondré K, Abrahamowicz M, Regeasse A, et al. . Statistical measures were proposed for identifying longitudinal patterns of change in quantitative health indicators. J Clin Epidemiol 2004;57:1049–62. 10.1016/j.jclinepi.2004.02.012
    1. Emrani PS, Katz JN, Kessler CL, et al. . Joint space narrowing and Kellgren–Lawrence progression in knee osteoarthritis: an analytic literature synthesis. Osteoarthritis Cartilage 2008;16:873–82. 10.1016/j.joca.2007.12.004
    1. Bartlett SJ, Ling SM, Mayo NE, et al. . Identifying common trajectories of joint space narrowing over two years in knee osteoarthritis. Arthritis Care Res 2011;63:1722–8. 10.1002/acr.20614
    1. Hawker GA, Stewart L, French MR, et al. . Understanding the pain experience in hip and knee osteoarthritis – an OARSI/OMERACT initiative. Osteoarthritis Cartilage 2008;16:415–22. 10.1016/j.joca.2007.12.017
    1. Arthritis Research UK. Osteoarthritis: patient information booklet, 2012.
    1. Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology 2005;44:7–16. 10.1093/rheumatology/keh344
    1. Smith TO, Zou K, Abdullah N, et al. . Does flare trial design affect the effect size of non-steroidal anti-inflammatory drugs in symptomatic osteoarthritis? A systematic review and meta-analysis. Ann Rheum Dis 2016;75:1971–8. 10.1136/annrheumdis-2015-208823
    1. Marty M, Hilliquin P, Rozenberg S, et al. . Validation of the KOFUS (Knee Osteoarthritis Flare-Ups Score). Joint Bone Spine 2009;76:268–72. 10.1016/j.jbspin.2008.07.018
    1. Rutjes AS, Jüni P, Da Costa BR, et al. . Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med 2012;157:180–91.
    1. Thomas J, Harden A, Newman M. Synthesis: Combining results systematically and appropriately : Gough A, Oliver S, Thomas J, An introduction to systematic reviews. London: Sage publications limited, 2013:191–2.
    1. Popay J, Roberts H SA. Guidance on the conduct of narrative synthesis in systematic reviews: a product of the ESRC methods programme. Lancaster: ESRC Method Programme, 2006.
    1. Altman R, Hochberg M, Gibofsky A, et al. . Efficacy and safety of low-dose SoluMatrix meloxicam in the treatment of osteoarthritis pain: a 12-week, phase 3 study. Curr Med Res Opin 2015;31:2331–43. 10.1185/03007995.2015.1112772
    1. Atukorala I, Pathmeswaran A, Makovey J, et al. . Is there a relationship between the Intermittent and Constant Osteoarthritis Pain score (ICOAP) and pain flares in knee osteoarthritis? Osteoarthritis Cartilage 2016;24:S429–30. 10.1016/j.joca.2016.01.775
    1. Baer PA, Thomas LM, Shainhouse Z. Treatment of osteoarthritis of the knee with a topical diclofenac solution: a randomised controlled, 6-week trial [ISRCTN53366886]. BMC Musculoskelet Disord 2005;6:44 10.1186/1471-2474-6-44
    1. Baraf HSB, Gloth FM, Barthel HR, et al. . Safety and Efficacy of Topical Diclofenac Sodium Gel for Knee Osteoarthritis in Elderly and Younger Patients. Drugs Aging 2011;28:27–40. 10.2165/11584880-000000000-00000
    1. Battisti WP, Katz NP, Weaver AL, et al. . Pain management in osteoarthritis: A focus on onset of efficacy—a comparison of rofecoxib, celecoxib, acetaminophen, and nabumetone across four clinical trials. The Journal of Pain 2004;5:511–20. 10.1016/j.jpain.2004.09.004
    1. Bingham CO, Sebba AI, Rubin BR, et al. . Efficacy and safety of etoricoxib 30 mg and celecoxib 200 mg in the treatment of osteoarthritis in two identically designed, randomized, placebo-controlled, non-inferiority studies. Rheumatology 2007;46:496–507. 10.1093/rheumatology/kel296
    1. Birbara C, Ruoff G, Sheldon E, et al. . Efficacy and safety of rofecoxib 12.5 mg and celecoxib 200 mg in two similarly designed osteoarthritis studies. Curr Med Res Opin 2006;22:199–210. 10.1185/030079906X80242
    1. Bocanegra TS, Weaver AL, Tindall EA, et al. . Diclofenac/misoprostol compared with diclofenac in the treatment of osteoarthritis of the knee or hip: a randomized, placebo controlled trial. Arthrotec Osteoarthritis Study Group. J Rheumatol 1998;25:1602–11.
    1. Boswell DJ, Ostergaard K, Philipson RS, et al. . Evaluation of GW406381 for treatment of osteoarthritis of the knee: two randomized, controlled studies. Medscape J Med 2008;10:259.
    1. Brandt KD, Mazzuca SA, Buckwalter KA, et al. . Acetaminophen, like conventional NSAIDs, may reduce synovitis in osteoarthritic knees. Rheumatology 2006;45:1389–94. 10.1093/rheumatology/kel100
    1. Case JP, Baliunas AJ, Block JA. Lack of efficacy of acetaminophen in treating symptomatic knee osteoarthritis: a randomized, double-blind, placebo-controlled comparison trial with diclofenac sodium. Arch Intern Med 2003;163:169–78.
    1. Ehrich EW, Schnitzer TJ, McIlwain H, et al. . Effect of specific COX-2 inhibition in osteoarthritis of the knee: a 6 week double blind, placebo controlled pilot study of rofecoxib. Rofecoxib Osteoarthritis Pilot Study Group. J Rheumatol 1999;26:2438–47.
    1. Essex MN, O’Connell M, Bhadra Brown P. Response to nonsteroidal anti-inflammatory drugs in African Americans with osteoarthritis of the knee. J Int Med Res 2012;40:2251–66. 10.1177/030006051204000623
    1. Gibofsky A, Hochberg MC, Jaros MJ, et al. . Efficacy and safety of low-dose submicron diclofenac for the treatment of osteoarthritis pain: a 12 week, phase 3 study. Curr Med Res Opin 2014;30:1883–93. 10.1185/03007995.2014.946123
    1. Gineyts E, et al. . Effects of ibuprofen on molecular markers of cartilage and synovium turnover in patients with knee osteoarthritis. Ann Rheum Dis 2004;63:857–61. 10.1136/ard.2003.007302
    1. Goldberg M, McIlwain H, Poiley J, et al. . Controlled-release naproxen in the treatment of osteoarthritis. Current Therapeutic Research-Clinical and Experimental 1988;44:51–60.
    1. Gottesdiener K, et al. . Results of a randomized, dose-ranging trial of etoricoxib in patients with osteoarthritis. Rheumatology 2002;41:1052–61. 10.1093/rheumatology/41.9.1052
    1. Hochberg MC, Fort JG, Svensson O, et al. . Fixed-dose combination of enteric-coated naproxen and immediate-release esomeprazole has comparable efficacy to celecoxib for knee osteoarthritis: two randomized trials. Curr Med Res Opin 2011;27:1243–53. 10.1185/03007995.2011.580340
    1. Katz N, Sun S, Johnson F, et al. . ALO-01 (Morphine Sulfate and Naltrexone Hydrochloride) Extended-Release Capsules in the Treatment of Chronic Pain of Osteoarthritis of the Hip or Knee: Pharmacokinetics, Efficacy, and Safety. The Journal of Pain 2010;11:303–11. 10.1016/j.jpain.2009.07.017
    1. Kivitz AJ, Makarowski WS, Fiechtner JJ, et al. . A flexible daily dosage regimen of oxaprozin potassium in patients with acute knee pain associated with osteoarthritis. Clin Drug Investig 2001;21:745–53. 10.2165/00044011-200121110-00002
    1. Erfani T, Zhang Y, Makovey J, et al. . Intermittent analgesic use and risk of pain exacerbation in knee osteoarthritis: A web based case-crossover study. Arthritis and Rheumatology 2014;66.
    1. Leung AT, Malmstrom K, Gallacher AE, et al. . Efficacy and tolerability profile of etoricoxib in patients with osteoarthritis: a randomized, double-blind, placebo and active-comparator controlled 12-week efficacy trial. Curr Med Res Opin 2002;18:49–58. 10.1185/030079902125000282
    1. Luyten FP, Geusens P, Malaise M, et al. . A prospective randomised multicentre study comparing continuous and intermittent treatment with celecoxib in patients with osteoarthritis of the knee or hip. Ann Rheum Dis 2007;66:99–106. 10.1136/ard.2006.052308
    1. Manicourt D-H, Bevilacqua M, Righini V, et al. . Comparative Effect of Nimesulide and??Ibuprofen on the Urinary Levels of??Collagen Type II C-telopeptide degradation products and on the serum levels of hyaluronan and matrix metalloproteinases-3 and -13 in??Patients with flare-up of osteoarthritis. Drugs R D 2005;6:261–71. 10.2165/00126839-200506050-00002
    1. Mazzuca SA, Brandt KD, Lane KA, et al. . Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees. Arthritis Rheum 2002;46:1223–7. 10.1002/art.10256
    1. McIlwain H, Silverfield JC, Cheatum DE, et al. . Intra-articular orgotein in osteoarthritis of the knee: a placebo-controlled efficacy, safety, and dosage comparison. Am J Med 1989;87:295–300. 10.1016/S0002-9343(89)80154-8
    1. Mendelsohn S. Clinical efficacy and tolerability of naproxen in osteoarthritis patients using twice-daily and once-daily regimens. Clinical therapeutics 1991;13:8–15.
    1. Moskowitz RW, Sunshine A, Hooper M, et al. . An analgesic model for assessment of acute pain response in osteoarthritis of the knee. Osteoarthritis Cartilage 2006;14:1111–8. 10.1016/j.joca.2006.05.004
    1. Pareek A, Chandurkar N, Sharma VD, et al. . A randomized, multicentric, comparative evaluation of aceclofenac–paracetamol combination with aceclofenac alone in Indian patients with osteoarthritis flare-up. Expert Opin Pharmacother 2009;10:727–35. 10.1517/14656560902781931
    1. Pareek A, Chandurkar N, Ambade R, et al. . Efficacy and safety of etodolac-paracetamol fixed dose combination in patients with knee osteoarthritis flare-up: a randomized, double-blind comparative evaluation. Clin J Pain 2010;26:561–6. 10.1097/AJP.0b013e3181e15bba
    1. Ricci JA, Stewart WF, Chee E, et al. . Pain exacerbation as a major source of lost productive time in US workers with arthritis. Arthritis & Rheumatism 2005;53:673–81. 10.1002/art.21453
    1. Schnitzer TJ, Fricke JR, Gitton X, et al. . Lumiracoxib in the treatment of osteoarthritis, rheumatoid arthritis and acute postoperative dental pain: results of three dose-response studies. Curr Med Res Opin 2005;21:151–61. 10.1185/030079904X20231
    1. Scott-Lennox JA, McLaughlin-Miley C, Lennox RD, et al. . Stratification of flare intensity identifies placebo responders in a treatment efficacy trial of patients with osteoarthritis. Arthritis & Rheumatism 2001;44:1599–607. 10.1002/1529-0131(200107)44:7<1599::AID-ART283>;2-N
    1. Silverfield JC, Kamin M, Wu S-C, et al. . Tramadol/acetaminophen combination tablets for the treatment of osteoarthritis flare pain: a multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group, add-on study. Clin Ther 2002;24:282–97. 10.1016/S0149-2918(02)85024-X
    1. Strand V, Simon LS, Dougados M, et al. . Treatment of osteoarthritis with continuous versus intermittent celecoxib. J Rheumatol 2011;38:2625–34. 10.3899/jrheum.110636
    1. Wiesenhutter CW, Boice JA, Ko A, et al. . Evaluation of the comparative efficacy of etoricoxib and ibuprofen for treatment of patients with osteoarthritis: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc 2005;80:470–9. 10.4065/80.4.470
    1. Williams GW, Hubbard RC, Yu SS, et al. . Comparison of once-daily and twice-daily administration of celecoxib for the treatment of osteoarthritis of the knee. Clin Ther 2001;23:213–27. 10.1016/S0149-2918(01)80004-7
    1. Wittenberg R, Schell E, Krehan G, et al. . First-dose analgesic effect of the cyclo-oxygenase-2 selective inhibitor lumiracoxib in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled comparison with celecoxib NCT00267215]. Arthritis Res Ther 2006;8:R35 10.1186/ar1854
    1. Yeasted R, McPherson J, Schnitzer T. Characterization of osteoarthritis pain variability. Osteoarthritis Cartilage 2014;22:S390–1. 10.1016/j.joca.2014.02.728
    1. Young C, Parenti D, Hochberg M. Lower-dose diclofenac capsules developed using solumatrix fine particle technology result in clinically meaningful improvements in pain in a phase 3 study of patients with osteoarthritis. Osteoarthritis Cartilage 2014;22:S399 10.1016/j.joca.2014.02.747
    1. Zhao SZ, McMillen JI, Markenson JA, et al. . Evaluation of the functional status aspects of health-related quality of life of patients with osteoarthritis treated with celecoxib. Pharmacotherapy 1999;19:1269–78. 10.1592/phco.19.16.1269.30879
    1. Zobel I, Erfani T, Bennell K, et al. . Relationship of buckling and knee injury to pain exacerbation in knee osteoarthritis: A web-based case-crossover stud. Interact J Med Res 2014;66:S560–1.
    1. Conrozier T, Mathieu P, Vignon E, et al. . Differences in the osteoarthritic synovial fluid composition and rheology between patients with or without flare: a pilot study. Clin Exp Rheumatol 2012;30:729–34.
    1. D’Agostino MA, Conaghan P, Le Bars M, et al. . EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis 2005;64:1703–9. 10.1136/ard.2005.037994
    1. Jawad ASM. Analgesics and osteoarthritis: are treatment guidelines reflected in clinical practice? Am J Ther 2005;12:98–103. 10.1097/00045391-200501000-00013
    1. Murphy SL, Lyden AK, Kratz AL, et al. . Characterizing pain flares from the perspective of individuals with symptomatic knee osteoarthritis. Arthritis Care Res 2015;67:1103–11. 10.1002/acr.22545
    1. Wise BL, Niu J, Zhang Y, et al. . Psychological factors and their relation to osteoarthritis pain. Osteoarthritis Cartilage 2010;18:883–7. 10.1016/j.joca.2009.11.016
    1. Zhang Y, Zhang B, Wise B, et al. . Statistical approaches to evaluating the effect of risk factors on the pain of knee osteoarthritis in longitudinal studies. Curr Opin Rheumatol 2009;21:513–9. 10.1097/BOR.0b013e32832ed69d
    1. Zhang Y, Wheaton D N. Recent heavy physical activities trigger knee pain exacerbation in persons with symptomatic knee osteoarthritis. Arthritis & Rheumatism 2011;63.
    1. Day R, Morrison B, Luza A, et al. . A randomized trial of the efficacy and tolerability of the COX-2 inhibitor rofecoxib vs ibuprofen in patients with osteoarthritis. Rofecoxib/Ibuprofen Comparator Study Group. Arch Intern Med 2000;160:1781–7. 10.1001/archinte.160.12.1781
    1. Kivitz AJ, Greenwald MW, Cohen SB, et al. . Efficacy and safety of rofecoxib 12.5 mg versus nabumetone 1,000 mg in patients with osteoarthritis of the knee: a randomized controlled trial. J Am Geriatr Soc 2004;52:666–74. 10.1111/j.1532-5415.2004.52201.x
    1. Bingham CO, Smugar SS, Wang H, et al. . Predictors of response to cyclo-oxygenase-2 inhibitors in osteoarthritis: pooled results from two identical trials comparing etoricoxib, celecoxib, and placebo. Pain Medicine 2011;12:352–61. 10.1111/j.1526-4637.2011.01060.x
    1. Essex MN, Behar R, O’Connell MA, et al. . Efficacy and tolerability of celecoxib and naproxen vs placebo in hispanic patients with knee osteoarthritis. Osteoarthritis Cartilage 2013;21:S252 10.1016/j.joca.2013.02.521
    1. Yocum D, Fleischmann R, Dalgin P, et al. . Safety and efficacy of meloxicam in the treatment of osteoarthritis: a 12-week, double-blind, multiple-dose, placebo-controlled trial. The Meloxicam Osteoarthritis Investigators. Arch Intern Med 2000;160:2947–54.
    1. Atukorala I, Pathmeswaran A, Chang T, et al. . SAT0452 do traditional risk factors for knee osteoarthritis predict pain flares in knee osteoarthritis?: Table 1. Ann Rheum Dis 2016;75:835.2–835. 10.1136/annrheumdis-2016-eular.3335
    1. Bartholdy C, Klokker L, Bandak E, et al. . A standardized “rescue” exercise program for symptomatic flare-up of knee osteoarthritis: description and safety considerations. Journal of Orthopaedic & Sports Physical Therapy 2016;46:942–6. 10.2519/jospt.2016.6908
    1. Bassiouni H. Detection of changes in the serum and synovial fluid levels of resistin during flare ups and remissions in primary knee osteoarthritis. Arthritis and Rheumatology 2015;67.
    1. Erfani T, Makovey J, Bennell K, et al. . Psychosocial factors and pain exacerbation in knee osteoarthritis: a web based case-crossover study. Intern Med J 2014;44:16.
    1. Ferreira ML, Zhang Y, Metcalf B, et al. . The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis – a case-crossover study. Osteoarthritis Cartilage 2016;24:2042–7. 10.1016/j.joca.2016.07.016
    1. Hunter DJ, Bennell K, Makovey J, et al. . Psychosocial factors and pain exacerbation in knee osteoarthritis: a web based case-crossover study. Osteoarthritis Cartilage 2014;22:S21–S22. 10.1016/j.joca.2014.02.062
    1. Makovey J, Metcalf B, Zhang Y, et al. . Web-based study of risk factors for pain exacerbation in osteoarthritis of the knee (SPARK-Web): design and rationale. JMIR Res Protoc 2015;4:e80 10.2196/resprot.4406
    1. Parry E, Ogollah R, Peat G. Significant pain variability in persons with, or at high risk of, knee osteoarthritis: preliminary investigation based on secondary analysis of cohort data. BMC Musculoskelet Disord 2017;18:80 10.1186/s12891-017-1434-3
    1. Cibere J, Kopec JA, Thorne A, et al. . Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis. Arthritis & Rheumatism 2004;51:738–45. 10.1002/art.20697
    1. Cibere J, Thorne A, Kopec JA, et al. . Glucosamine sulfate and cartilage type II collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers. J Rheumatol 2005;32:896–902.
    1. Roth SH, Shainhouse JZ. Efficacy and safety of a topical diclofenac solution (pennsaid) in the treatment of primary osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled clinical trial. Arch Intern Med 2004;164:2017–23. 10.1001/archinte.164.18.2017
    1. Simon LS, Grierson LM, Naseer Z, et al. . Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis. Pain 2009;143:238–45. 10.1016/j.pain.2009.03.008
    1. Weaver A, Rubin B, Caldwell J, et al. . Comparison of the efficacy and safety of oxaprozin and nabumetone in the treatment of patients with osteoarthritis of the knee. Clin Ther 1995;17:735–45. 10.1016/0149-2918(95)80050-6
    1. Rother M, Lavins BJ, Kneer W, et al. . Efficacy and safety of epicutaneous ketoprofen in Transfersome (IDEA-033) versus oral celecoxib and placebo in osteoarthritis of the knee: multicentre randomised controlled trial. Ann Rheum Dis 2007;66:1178–83. 10.1136/ard.2006.065128
    1. Zobel I, Erfani T, Bennell KL, et al. . Relationship of buckling and knee injury to pain exacerbation in knee osteoarthritis: a web-based case-crossover study. Interact J Med Res 2016;5:e17 10.2196/ijmr.5452
    1. Woolacott NF, Corbett MS, Rice SJC. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology 2012;51:1440–6. 10.1093/rheumatology/kes043
    1. National Institute for Health and Care Excellence (NICE). Osteoarthritis: care and management (CG177). London: NICE, 2014.
    1. Buttgereit F, Burmester G-R, Bijlsma JWJ. Non-surgical management of knee osteoarthritis: where are we now and where do we need to go? RMD Open 2015;1:e000027 10.1136/rmdopen-2014-000027
    1. Porcheret M, Healey E, Dziedzic K, et al. . Ostoearthritis: a modern approach to diagnosis and management. Arthritis Research UK 2011;6.
    1. Bellamy N, Sothern RB, Campbell J. Rhythmic variations in pain perception in osteoarthritis of the knee. J Rheumatol 1990;17:364–72.
    1. Allen KD, Coffman CJ, Golightly YM, et al. . Daily pain variations among patients with hand, hip, and knee osteoarthritis. Osteoarthritis Cartilage 2009;17:1275–82. 10.1016/j.joca.2009.03.021
    1. Makris D, Bouros D. COPD exacerbation: lost in translation. BMC Pulm Med 2009;9:6 10.1186/1471-2466-9-6
    1. Fitzgerald JD, Grossman JM. Validity and reliability of retrospective assessment of disease activity and flare in observational cohorts of lupus patients. Lupus 1999;8:638–44. 10.1191/096120399680411443
    1. Lewis JD, Aberra FN, Lichtenstein GR, et al. . Seasonal variation in flares of inflammatory bowel disease. Gastroenterology 2004;126:665–73. 10.1053/j.gastro.2003.12.003
    1. Suri P, Saunders KW, Von Korff M. Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care. Clin J Pain 2012;28:573–80. 10.1097/AJP.0b013e31823ae173
    1. Cross M, Dubouis L, Mangin M, et al. . Defining flare in osteoarthritis of the hip and knee: a systematic literature review — omeract virtual special interest group. J Rheumatol 2017;44:1920–7. 10.3899/jrheum.161107
    1. Sands GH, Brown PB, Essex MN. The efficacy of continuous versus intermittent celecoxib treatment in osteoarthritis patients with Body Mass Index ≥30 and <30 kg/m(2.). Open Rheumatol J 2013;7:32–7. 10.2174/1874312901307010032
    1. Berthelot J-M, De Bandt M, Morel J, et al. . A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: The ‘FLARE’ instrument. Ann Rheum Dis 2012;71:1110–6. 10.1136/ard.2011.150656

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit