Perspectives of flares in people with knee OA: a qualitative study

Problem

Acute flares in osteoarthritis (OA) are important but poorly understood. There is uncertainty around their nature, impact and how they are managed. This qualitative study explored understanding and experiences of flares in people with knee OA, and self-management and help-seeking strategies.

Approach

Ethics approvals obtained.

Semi-structured interviews conducted with 15 participants from two general practices in the West Midlands. Participants were aged over 45 years, had consulted in the previous 2 years for knee OA, and reported experiencing at least one flare in the previous 12 months. Interviews were conducted by EP and participants were invited to draw a diagram of their pain experience over the previous 6 months to aid discussion. Thematic analysis using constant comparison methods was conducted using an iterative approach. Data generation continued until data saturation was achieved.

Findings

Four main themes were identified: experiencing pain, consequences of acute pain, predicting and avoiding acute pain, and response to acute pain.

Participants described minor episodes of pain which tended to be fleeting, frequent, had minimal impact, and generally occurred during everyday activity such as walking or stair climbing. This contrasted with more severe episodes which were infrequent, had greater impact, were less likely to be predictable and led to emotional exhaustion. These severe pain episodes generally led to feelings of low confidence, vulnerability and feelings of being a burden. The term ‘flare’ was often used to describe the more severe events, but was applied inconsistently. Several participants described the guilt they felt after perceiving to have ‘overdone’ things.

Participants reported avoiding or adapting activities, sometimes resentfully, and used a range of self-management strategies including non-pharmacological methods and over-the-counter analgesia. They tended to seek help when these strategies had been exhausted or their symptoms led to emotional distress, disturbed sleep, or pain experience worse than usual. Previous experiences shaped whether people sought help.

Consequences

From the perspective of people with OA there appears to be no fixed clear understanding of a flare. Severe episodes of pain in OA, however, are likely to be synonymous with flares. These episodes are important as they can lead to productivity loss and impact on valued activities. Minor episodes of pain tended to occur with activity and were short-lived, and it is unclear whether these episodes represent a spectrum of flare severity or variability of OA symptoms. It is uncertain if differentiating between these episodes of different severities is useful to people with OA, clinicians or researchers. Developing a shared common language about flares will allow a shared understanding of these events, early identification and appropriate management.