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  1. Article ; Online: Recognising and managing osteoarthritis flares in primary care.

    Parry, Emma / Walker, Christine / Thomas, Martin J

    BMJ (Clinical research ed.)

    2023  Volume 383, Page(s) e076455

    MeSH term(s) Humans ; Osteoarthritis, Knee ; Primary Health Care
    Language English
    Publishing date 2023-10-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2023-076455
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  2. Article: An Evaluation of Different Strategies for Sampling Controls in an Online Case-Crossover Study of Acute Flares in Knee Osteoarthritis.

    Rathod-Mistry, Trishna / Peat, George / Neogi, Tuhina / Thomas, Martin J

    Clinical epidemiology

    2023  Volume 15, Page(s) 635–644

    Abstract: Objective: To evaluate bias and precision of exposure-outcome effect estimates from three control sampling strategies in a case-crossover study.: Methods: Online case-crossover study investigating eight physical activity-related triggers for acute ... ...

    Abstract Objective: To evaluate bias and precision of exposure-outcome effect estimates from three control sampling strategies in a case-crossover study.
    Methods: Online case-crossover study investigating eight physical activity-related triggers for acute flares in knee osteoarthritis. Exposures were measured in hazard periods (≤24 hours before self-declared flare onset). Control period exposure was measured in three ways: (1) four scheduled questionnaires over 13-weeks, (2) "usual" physical activity levels ascertained at baseline, (3) over three days before flare onset. Derived odds ratios, 95% confidence intervals and standard errors were compared.
    Results: Of 744 participants (mean age 62.1 [SD 10.2] years; 61% female), 493 reported 714 flares. Selecting controls from scheduled questionnaires, independent of hazard periods, yielded predominantly odds ratios in the expected direction (exposure "a lot" versus exposure "not at all", range: 0.57-3.22). When controls were sampled at baseline (range: 0.01-1.42) or immediately before a flare (range: 0.30-1.27) most odds ratio estimates were inverted. Standard errors of the log odds ratios were smallest when controls were sampled from scheduled questionnaires (range: 0.264-0.473) compared to controls sampled at baseline (range: 0.267-0.589) or immediately before a flare (range: 0.319-0.621).
    Conclusion: Our findings are sensitive to control sample selection. Under certain conditions, different patterns could be attributed to over reporting and social desirability bias, where people may want to present themselves more positively about their "usual" physical activity levels, at baseline. Exposure measurement at the time of a flare may be less precise and more susceptible to recall bias due to systematically reporting exposures differently during a flare, compared to control measurement independent of flares.
    Language English
    Publishing date 2023-05-16
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2494772-6
    ISSN 1179-1349
    ISSN 1179-1349
    DOI 10.2147/CLEP.S401488
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  3. Article ; Online: Prediction Models to Estimate the Future Risk of Osteoarthritis in the General Population: A Systematic Review.

    Appleyard, Tom / Thomas, Martin J / Antcliff, Deborah / Peat, George

    Arthritis care & research

    2023  Volume 75, Issue 7, Page(s) 1481–1493

    Abstract: Objective: To evaluate the performance and applicability of multivariable prediction models for osteoarthritis (OA).: Methods: This was a systematic review and narrative synthesis using 3 databases (EMBASE, PubMed, and Web of Science) from inception ... ...

    Abstract Objective: To evaluate the performance and applicability of multivariable prediction models for osteoarthritis (OA).
    Methods: This was a systematic review and narrative synthesis using 3 databases (EMBASE, PubMed, and Web of Science) from inception to December 2021. We included general population longitudinal studies reporting derivation, comparison, or validation of multivariable models to predict individual risk of OA incidence, defined by recognized clinical or imaging criteria. We excluded studies reporting prevalent OA and joint arthroplasty outcome. Paired reviewers independently performed article selection, data extraction, and risk-of-bias assessment. Model performance, calibration, and retained predictors were summarized.
    Results: A total of 26 studies were included, reporting 31 final multivariable prediction models for incident knee (23), hip (4), hand (3) and any-site OA (1), with a median of 121.5 (range 27-12,803) outcome events, a median prediction horizon of 8 years (range 2-41), and a median of 6 predictors (range 3-24). Age, body mass index, previous injury, and occupational exposures were among the most commonly included predictors. Model discrimination after validation was generally acceptable to excellent (area under the curve = 0.70-0.85). Either internal or external validation processes were used in most models, although the risk of bias was often judged to be high with limited applicability to mass application in diverse populations.
    Conclusion: Despite growing interest in multivariable prediction models for incident OA, focus remains predominantly on the knee, with reliance on data from a small pool of appropriate cohort data sets, and concerns over general population applicability.
    MeSH term(s) Humans ; Osteoarthritis/diagnosis ; Osteoarthritis/epidemiology ; Knee Joint ; Bias
    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25035
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  4. Article ; Online: Osteoarthritis Flares.

    Thomas, Martin J / Guillemin, Francis / Neogi, Tuhina

    Clinics in geriatric medicine

    2022  Volume 38, Issue 2, Page(s) 239–257

    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 ... ...

    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.
    MeSH term(s) Humans ; Osteoarthritis, Knee
    Language English
    Publishing date 2022-04-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1064151-8
    ISSN 1879-8853 ; 0749-0690
    ISSN (online) 1879-8853
    ISSN 0749-0690
    DOI 10.1016/j.cger.2021.11.001
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  5. Article ; Online: A scoping review of patient self-report measures of flare in knee and hip osteoarthritis (OA): A report from the OMERACT flares in OA working group.

    Queiroga, Fabiana / Cross, Marita / Thomas, Martin J / March, Lyn / Epstein, Jonathan / Guillemin, Francis

    Seminars in arthritis and rheumatism

    2023  Volume 63, Page(s) 152281

    Abstract: Purpose: We aimed to analyze the content validity/domain match and feasibility of self-report instruments that could measure flare in osteoarthritis (OA), by extending our 2017 literature review on the definition of flare in knee and hip OA.: Method: ...

    Abstract Purpose: We aimed to analyze the content validity/domain match and feasibility of self-report instruments that could measure flare in osteoarthritis (OA), by extending our 2017 literature review on the definition of flare in knee and hip OA.
    Method: We searched PubMed (Medline), Web of Science and PsycInfo (Ebsco Host) databases for original articles reporting research about flare (or synonyms) in humans with knee and hip OA, between 2017 and 2023. Four experts worked independently, checking the records, and assessing content validity and feasibility, writing justification for exclusion.
    Results: At literature review phase, 575 papers were filtered. After experts' analysis, 59 studies were included, and 44 instruments associated with flare in OA were identified. Most were studies about pain in knee or hip OA (35 %), cultural adaptation of a measure (33 %) or studies investigating psychometric properties of full (16 %) or short form (4 %) instruments. The assessment of domain match and feasibility revealed that 15 instruments were assigned a label of 'yes' or 'uncertain' as to whether or not there was a good match with the domain concept or whether the instrument was considered feasible to use.
    Discussion: Most identified instruments considered different aspects of pain and the associated discomfort in performing daily activities but did not include the central aspects of flare in OA, i.e. the change of state, nor the additional Outcome Measures in Rheumatology (OMERACT) endorsed domains for OA flare namely stiffness, swelling, psychological aspects, impact of symptoms including fatigue and sleep disturbance. Although it is possible that the period specified to conduct this literature review may have led to some recognized instruments being excluded, this review demonstrates the need for the research community to reach consensus on the best way to measure self-reported flares in future clinical trials and observational studies.
    MeSH term(s) Humans ; Osteoarthritis, Hip/diagnosis ; Self Report ; Knee Joint ; Consensus ; Pain/diagnosis ; Pain/etiology ; Osteoarthritis, Knee/diagnosis
    Language English
    Publishing date 2023-10-14
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 120247-9
    ISSN 1532-866X ; 0049-0172
    ISSN (online) 1532-866X
    ISSN 0049-0172
    DOI 10.1016/j.semarthrit.2023.152281
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  6. Article ; Online: Structural Foot Characteristics in People With Midfoot Osteoarthritis: Cross-Sectional Findings From the Clinical Assessment Study of the Foot.

    Lithgow, Merridy J / Buldt, Andrew K / Munteanu, Shannon E / Marshall, Michelle / Thomas, Martin J / Peat, George / Roddy, Edward / Menz, Hylton B

    Arthritis care & research

    2023  Volume 76, Issue 2, Page(s) 225–230

    Abstract: Objective: This study compared radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA).: Methods: This was a cross-sectional study of adults aged 50 years and older registered with ... ...

    Abstract Objective: This study compared radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA).
    Methods: This was a cross-sectional study of adults aged 50 years and older registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last 4 weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular-first cuneiform, and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a 5-year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent sample t-tests and effect sizes (Cohen's d).
    Results: We identified 63 midfoot OA cases (mean ± SD age was 66.8 ± 8.0 years, with 32 male and 31 female participants) and matched these to 63 controls (mean ± SD age was 65.9 ± 7.8 years). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal-first metatarsal angle (d = 0.43, small effect size, P = 0.018) and lower calcaneal inclination angle (d = 0.46, small effect size, P = 0.011) compared with controls.
    Conclusions: People with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross-sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition.
    MeSH term(s) Adult ; Humans ; Male ; Female ; Middle Aged ; Aged ; Cross-Sectional Studies ; Foot/diagnostic imaging ; Osteoarthritis/diagnostic imaging ; Foot Joints/diagnostic imaging ; Pain
    Language English
    Publishing date 2023-10-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25217
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  7. Article ; Online: Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot.

    Lithgow, Merridy J / Buldt, Andrew K / Munteanu, Shannon E / Marshall, Michelle / Thomas, Martin J / Peat, George / Roddy, Edward / Menz, Hylton B

    Gait & posture

    2023  Volume 108, Page(s) 243–249

    Abstract: Background: Midfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to ... ...

    Abstract Background: Midfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition.
    Research question: To compare plantar pressures between people with and without symptomatic radiographic midfoot OA.
    Methods: This was a cross-sectional study of adults aged ≥ 50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age ( ± 5 years) to controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen's d).
    Results: We included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p = <0.001) and pressure at the midfoot (d=0.70, medium effect size, p = <0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p = 0.13), and fifth MTP joint (d=0.37, small effect size, p = 0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p = 0.13). They also displayed lower force (d=0.40, small effect size, p = 0.02) and pressure at the hallux (d=0.50, medium effect size, p = <0.001) and lower force (d=0.54, medium effect size, p = <0.001) and pressure at the lesser toes (d=0.48, small effect size, p = <0.001) compared with controls.
    Significance: Midfoot OA appears to be associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships.
    MeSH term(s) Male ; Adult ; Female ; Humans ; Aged ; Cross-Sectional Studies ; Foot ; Osteoarthritis ; Hallux ; Pain
    Language English
    Publishing date 2023-12-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1162323-8
    ISSN 1879-2219 ; 0966-6362
    ISSN (online) 1879-2219
    ISSN 0966-6362
    DOI 10.1016/j.gaitpost.2023.12.008
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  8. Article ; Online: Defining Symptomatic Radiographic Foot Osteoarthritis: Comment on the Article by Golightly and Gates.

    Roddy, Edward / Thomas, Martin J / Menz, Hylton B / Munteanu, Shannon / Marshall, Michelle / Peat, George

    Arthritis care & research

    2021  Volume 73, Issue 11, Page(s) 1697–1698

    MeSH term(s) Foot Joints ; Humans ; Osteoarthritis/diagnostic imaging
    Language English
    Publishing date 2021-09-21
    Publishing country United States
    Document type Letter ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.24380
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  9. Article ; Online: Defining acute flares in knee osteoarthritis: a systematic review.

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

    BMJ open

    2018  Volume 8, Issue 7, Page(s) e019804

    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 ...

    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.
    MeSH term(s) Acute Disease ; Humans ; Osteoarthritis, Knee/diagnosis ; Osteoarthritis, Knee/physiopathology ; Pain/diagnosis ; Pain/physiopathology ; Symptom Assessment
    Language English
    Publishing date 2018-07-19
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2017-019804
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  10. Article ; Online: Identifying Long-Term Trajectories of Foot Pain Severity and Potential Prognostic Factors: A Population-Based Cohort Study.

    Marshall, Michelle / Blagojevic-Bucknall, Milica / Rathod-Mistry, Trishna / Thomas, Martin J / Edwards, John J / Peat, George / Menz, Hylton B / Roddy, Edward

    Arthritis care & research

    2022  Volume 75, Issue 5, Page(s) 1123–1131

    Abstract: Objectives: To identify distinct foot pain trajectories over 7 years and examine their associations with potential prognostic factors.: Methods: Adults ages ≥50 years and registered with 4 general practices in North Staffordshire, UK were mailed a ... ...

    Abstract Objectives: To identify distinct foot pain trajectories over 7 years and examine their associations with potential prognostic factors.
    Methods: Adults ages ≥50 years and registered with 4 general practices in North Staffordshire, UK were mailed a baseline health survey. Those reporting current or recent foot pain were invited to attend a research assessment clinic. Follow-up was by repeated postal surveys at 18, 36, 54, and 84 months. Distinct trajectories of foot pain were explored using latent class growth analysis (LCGA). Subsequently, identified trajectories were combined into most and least progressive groups, and covariate-adjusted associations with a range of prognostic factors were examined.
    Results: Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and 2 or more follow-up time points. LCGA for foot pain severity (0-10 numerical rating scale) identified a 4-trajectory model: "mild, improving" (37%); "moderate, improving" (33%); "moderate-severe, persistent" (24%); and "severe, persistent" (6%). Compared with individuals in more favorable (improving) pain trajectories, those in less favorable (persistent) pain trajectories were more likely to be obese, have routine/manual and intermediate occupations, have poorer physical and mental health, have catastrophizing beliefs, have greater foot-specific functional limitation, and have self-assessed hallux valgus at baseline.
    Conclusions: Four distinct trajectories of foot pain were identified over a 7-year period, with one-third of individuals classified as having pain that is persistently moderate-severe and severe in intensity. The effect of intervening to target modifiable prognostic factors such as obesity and hallux valgus on long-term outcomes in people with foot pain requires investigation.
    MeSH term(s) Adult ; Humans ; Middle Aged ; Cohort Studies ; Hallux Valgus ; Prognosis ; Pain Measurement ; Pain ; Obesity
    Language English
    Publishing date 2022-11-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.24823
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