"You don't put it down to arthritis": A qualitative study of the first symptoms recalled by individuals with knee osteoarthritis.

As part of the first phase of the OARSI Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) initiative, we explored the first symptoms and experiences recalled by individuals with knee osteoarthritis (OA). This qualitative study, informed by qualitative description, was a secondary analysis of focus groups (n ​= ​17 groups) and one-on-one interviews (n ​= ​3) conducted in 91 individuals living with knee OA as part of an international study to better understand the OA pain experience. In each focus group or interview, participants were asked to describe their first symptoms of knee OA. We inductively coded these transcripts and conducted thematic analysis. Mean age of participants was 70 years (range 47-92) and 68 ​% were female. We developed four overarching themes: The earliest symptoms of knee OA are frequently insidious in onset, episodic and present long before individuals present to health professionals. These results highlight challenges to identifying people with knee OA early and support the development of specific classification criteria for EsSKOA to capture individuals at an early stage.

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© 2023 The Author(s).

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LKK reports support from Canadian Institutes of Health Research Doctoral Award, and grant funding from Physician Services Incorporated (PSI) Resident Grant; JWL reports a Pfizer research grant completed in 2021, unrelated to this work; QW reports support from Osteoarthritis and Cartilage as an Associate Editor for statistics; AT reports support from Osteoarthritis and Cartilage as an Associate Editor for statistics, IKH reports consulting fees from AbbVie, GSK and Grünenthal, and leadership role as the OARSI Board of Directors Secretary; CTA reports grant funding and consulting/honoraria from AbbVie, Novartis, Pfizer, and Servier; LSL reports consulting/honoraria from Arthro Therapeutics AB, Sweden, and participation on a DSMB board for AstraZeneca; ME reports grant funding from Swedish Research Council, ERC, ALF, Kock Foundations, Gustav V 80 ​Year ​B-day foundation, NORDFORSK, FOREUM, Foundation for support to people with movement disability in Skåne, Österlund Foundation, SUS donations, consulting from Cellcolabs AB, and leadership role as the OARSI President-elect; JR reports a leadership role on the OARSI Ethics & Governance Committee, Nominating Committee; and TN reports grant funding and consulting/honoraria from Pfizer/Lilly, Regeneron and Novartis. All other authors report no competing interests.