{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T06:22:55Z","timestamp":1780726975383,"version":"3.54.1"},"reference-count":29,"publisher":"The Journal of Rheumatology","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Beyond the exacerbation of pain in describing a flare in osteoarthritis (OA), patients and health professionals add other elements that deserve to be fully elucidated, such as effusion, swelling, and mobility limitation. To define and conceptualize the construct <jats:italic>flare<\/jats:italic> in OA, the objective was to identify the key variables, or symptoms, that worsen, and to clarify how these variables are described in the literature by patients and clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>A systematic review of the literature was conducted in Medline and PsychINFO. In brief, the search terms used were \u201costeoarthritis,\u201d \u201cknee,\u201d \u201chip,\u201d and \u201cflare.\u201d Specific characteristics of included studies were identified, including the type of study design, type of flare assessed, how the flare developed, and what definition of flare was used, including whether the definition was based on qualitative or quantitative analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Pain was the major factor in the definition of flare within these studies. Four components of flare were identified: pain, other factors, composite criteria, and global assessment. While the majority of studies reported flare as an increase in pain using standardized outcome measures, only 1 study reported the antecedents and consequences of a pain flare using qualitative methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The use of flare as an outcome or inclusion criterion in rheumatology trials is a common occurrence; however, this review highlights the wide variation in the definitions of OA flare currently in use and the emphasis on the measurement of pain. This variation in definition does not allow for direct comparison between trials and limits interpretation of evidence.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.161107","type":"journal-article","created":{"date-parts":[[2017,7,2]],"date-time":"2017-07-02T00:20:11Z","timestamp":1498954811000},"page":"1920-1927","source":"Crossref","is-referenced-by-count":34,"title":["Defining Flare in Osteoarthritis of the Hip and Knee: A Systematic Literature Review \u2014 OMERACT Virtual Special Interest Group"],"prefix":"10.3899","volume":"44","author":[{"given":"Marita","family":"Cross","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovic","family":"Dubouis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Mangin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Hunter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyn","family":"March","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Hawker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Guillemin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2017,7,1]]},"reference":[{"key":"2018112909375849000_44.12.1920.1","first-page":"729","article-title":"Differences in the osteoarthritic synovial fluid composition and rheology between patients with or without flare: a pilot study","volume":"30","author":"Conrozier","year":"2012","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909375849000_44.12.1920.2","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jbspin.2008.07.018","article-title":"Validation of the KOFUS (Knee Osteoarthritis Flare-Ups Score)","volume":"76","author":"Marty","year":"2009","journal-title":"Joint Bone Spine"},{"key":"2018112909375849000_44.12.1920.3","unstructured":"World Health Organization. International classification of functioning and health. WHO: Geneva; 2001."},{"key":"2018112909375849000_44.12.1920.4","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090369"},{"key":"2018112909375849000_44.12.1920.5","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1002\/acr.22545","article-title":"Characterizing pain flares from the perspective of individuals with symptomatic knee osteoarthritis","volume":"67","author":"Murphy","year":"2015","journal-title":"Arthritis Care Res"},{"key":"2018112909375849000_44.12.1920.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-012-2441-1"},{"key":"2018112909375849000_44.12.1920.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2009.11.016"},{"key":"2018112909375849000_44.12.1920.8","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20492"},{"key":"2018112909375849000_44.12.1920.9","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.2196\/resprot.4406","article-title":"Web-based study of risk factors for pain exacerbation in osteoarthritis of the knee (SPARK-Web): Design and rationale","volume":"4","author":"Makovey","year":"2015","journal-title":"JMIR Res Protoc"},{"key":"2018112909375849000_44.12.1920.10","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.2196\/ijmr.5452","article-title":"Relationship of buckling and knee injury to pain exacerbation in knee osteoarthritis: a web-based case-crossover study","volume":"5","author":"Zobel","year":"2016","journal-title":"Interact J Med Res"},{"key":"2018112909375849000_44.12.1920.11","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1016\/j.joca.2016.07.016","article-title":"The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis - a case-crossover study","volume":"24","author":"Ferreira","year":"2016","journal-title":"Osteoarthritis Cartilage"},{"key":"2018112909375849000_44.12.1920.12","doi-asserted-by":"publisher","DOI":"10.1016\/0149-2918(95)80050-6"},{"key":"2018112909375849000_44.12.1920.13","doi-asserted-by":"publisher","DOI":"10.1592\/phco.19.16.1269.30879"},{"key":"2018112909375849000_44.12.1920.14","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.19.2947"},{"key":"2018112909375849000_44.12.1920.15","first-page":"566","article-title":"Rofecoxib improves quality of life in patients with hip or knee osteoarthritis","volume":"132","author":"Theiler","year":"2002","journal-title":"Swiss Med Wkly"},{"key":"2018112909375849000_44.12.1920.16","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1002\/art.20697","article-title":"Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis","volume":"51","author":"Cibere","year":"2004","journal-title":"Arthritis Care Res"},{"key":"2018112909375849000_44.12.1920.17","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-6-44"},{"key":"2018112909375849000_44.12.1920.18","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.065128"},{"key":"2018112909375849000_44.12.1920.19","first-page":"259","article-title":"Evaluation of GW406381 for treatment of osteoarthritis of the knee: two randomized, controlled studies","volume":"10","author":"Boswell","year":"2008","journal-title":"Medscape J Med"},{"key":"2018112909375849000_44.12.1920.20","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2011.580340"},{"key":"2018112909375849000_44.12.1920.21","doi-asserted-by":"publisher","DOI":"10.1177\/030006051204000623"},{"key":"2018112909375849000_44.12.1920.22","doi-asserted-by":"publisher","DOI":"10.2174\/1874312901307010032"},{"key":"2018112909375849000_44.12.1920.23","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110636"},{"key":"2018112909375849000_44.12.1920.24","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2014.946123"},{"key":"2018112909375849000_44.12.1920.25","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.joca.2013.11.012","article-title":"The relationship between knee pain characteristics and symptom state acceptability in people with knee osteoarthritis","volume":"22","author":"Liu","year":"2014","journal-title":"Osteoarthritis Cartilage"},{"key":"2018112909375849000_44.12.1920.26","doi-asserted-by":"crossref","first-page":"942","DOI":"10.2519\/jospt.2016.6908","article-title":"A standardized \u201crescue\u201d exercise program for symptomatic flare-up of knee osteoarthritis: Description and safety considerations","volume":"46","author":"Bartholdy","year":"2016","journal-title":"J Orthop Sports Phys Ther"},{"key":"2018112909375849000_44.12.1920.27","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1185\/03007995.2015.1112772","article-title":"Efficacy and safety of low-dose SoluMatrix meloxicam in the treatment of osteoarthritis pain: a 12-week, phase 3 study","volume":"31","author":"Altman","year":"2015","journal-title":"Curr Med Res Opin"},{"key":"2018112909375849000_44.12.1920.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.013"},{"key":"2018112909375849000_44.12.1920.29","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.150656"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.161107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T19:22:19Z","timestamp":1543519339000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.161107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,1]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2017,12,1]]},"published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.3899\/jrheum.161107"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.161107","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,1]]}}}