Intended for healthcare professionals

Practice Practice Pointer

Recognising and managing osteoarthritis flares in primary care

BMJ 2023; 383 doi: (Published 09 October 2023) Cite this as: BMJ 2023;383:e076455
  1. Emma Parry, NIHR clinical lecturer and general practitioner1,
  2. Christine Walker, Research User Group member who has experience of multi-site osteoarthritis and flares2,
  3. Martin J Thomas, senior research fellow in clinical epidemiology and honorary specialist rheumatology and musculoskeletal physiotherapist1 3
  1. 1Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
  2. 2Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK (patient author)
  3. 3Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Staffordshire, UK
  1. Correspondence to: E Parry e.parry{at}

What you need to know

  • Osteoarthritis flares are sudden sustained increases in pain, swelling, and stiffness for at least 24 hours, worse than usual patterns, which may affect sleep and daily activities, and can lead to emotional exhaustion

  • Flares usually last three to eight days, and may resolve spontaneously or result in the need to take extra analgesia

  • Joints giving way and lack of muscle strength, some physical activities, low mood, poor sleep, and changes in ambient temperature may trigger flares

  • Discuss long term management with people experiencing osteoarthritis flares; this should include physical activity, exercise, and weight management if relevant, fast-response management for sudden-onset flares (eg, rationalised use of medication and short term relative rest), and consideration of personal flare triggers

A 52 year old woman who was diagnosed with knee osteoarthritis two years ago consults her general practitioner with a six day history of sudden-onset increase in right knee pain, morning stiffness, swelling, waking at night because of her symptoms, and difficulty with going up stairs. She has been resting more and taking ibuprofen for pain relief. She has experienced several similar episodes over the past few months, each lasting between a couple of days and a week. Although her symptoms are now slightly improving she would like to know how she should manage future flares.

Osteoarthritis is a chronic long term condition that typically affects the whole joint complex, leading to pain, stiffness, and loss of function.1 The 2022 osteoarthritis guidelines published by the UK National Institute for Health and Care Excellence (NICE) recognise the absence of evidence regarding osteoarthritis flares and their management.2 Similarly, international guidelines do not discuss flares comprehensively, and usually do so only in relation to management with intra-articular corticosteroid injections.345

In this article, we discuss how conversations in primary care consultations can …

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