Osteoarthritis Flares

Abstract

The phenomenon of flares is a common feature in the daily life of people with osteoarthritis (OA). Characterized by episodes of sudden-onset increases in signs and symptoms, their impact can often be distressing and disabling. Despite their potential to have both short-term and long-term consequences for patients across the whole course of the condition, their occurrence and optimal management are not fully understood. This article provides a contemporary perspective on defining OA flares and their potential triggers, and offers suggestions for how health professionals might explore flare patterns with patients in clinical practice and frame timely best-practice treatment approaches.

Keywords: Acute; Exacerbation; Flare; Management; Osteoarthritis; Pain; Symptom variability.

Fig. 1.

Conceptual model of causality for OA flares acknowledging the contribution of potential distal and proximal causes. Illustration based on the “Cone of causation.” (Adapted from Bracken MB. Risk, chance, and causation: Investigating the origins and treatment of disease. New Haven: Yale University press; 2013; with permission.)

Fig. 2.

Theoretical natural history of symptomatic OA progression. The impact of intermittent discrete (potentially benign) flare-up episodes (red bars) progress in frequency, intensity (height of bars), and duration (width of bars), with reducing periods of remission and capacity for complete symptom resolution. These acute symptom events drive the underlying disease process, eventually resulting in constant pain, complete loss of organ reserve (capacity to restore homeostasis), and synovial joint failure. Each red bar representing a flare-up is preceded by potential exposure flare-up triggers. The black vertical dashed line represents a period of time after which flare-ups may no longer be potentially benign. The black dotted line represents the course of pain over time. The blue dotted line represents the organ reserve over time, which theoretically may diminish whth repeated and/or frequent flare-ups. (From Thomas MJ, Neogi T. Flare-ups of osteoarthritis: what do they mean in the short-term and the long-term?. Osteoarthritis Cartilage. 2020;28(7):870-873. doi:10.1016/j.joca.2020.01.005; with permission.)

Fig. 3.

Examples of currently recommended self-management strategies and advice for OA^, that may serve well as short-term “fast” flare management strategies. Patients could be taught how to implement these alongside long-term “slower” management strategies such as condition education, weight loss (as required), and physical activity/exercise participation.^- (Courtesy of J Bowden, PhD and J Eyles, PhD, Institute of Bone and Joint Research, Sydney, NSW, Australia.)