How do people with knee osteoarthritis perceive and manage flares? A qualitative study

Abstract

BackgroundAcute flares in people with osteoarthritis (OA) are poorly understood. There is uncertainty around the nature of flares, their impact, and how these are managed.AimExplore understandings and experiences of flares in people with knee OA, describe self-management and help-seeking strategiesDesign & settingQualitative interview study of people with knee OA in England, United Kingdom.MethodSemi-structured interviews with 15 people with knee OA. Thematic analysis using constant comparison methods.ResultsWe identified four main themes: experiencing pain, consequences of acute pain, predicting and avoiding acute pain, and response to acute pain. People with OA described minor episodes which were frequent, fleeting, occurred during everyday activity, had minimal impact, and were generally predictable. This contrasted with severe episodes which were infrequent, had greater impact, and were less likely to be predictable. The latter generally led to feelings of low confidence, vulnerability and of being a burden. The term ‘flare’ was often used to describe the severe events but this was applied inconsistently and some would describe a flare as any increase in pain.Participants used numerous self-management strategies but tended to seek help when these had been exhausted, their symptoms led to emotional distress, disturbed sleep, or pain experience worse than usual. Previous experiences shaped whether people sought help and who they sought help from.ConclusionSevere episodes of pain are likely to be synonymous with flares. Developing a common language about flares will allow a shared understanding of these events, early identification and appropriate management.