Is There a Dose‐Response Relationship Between Weight Loss and Symptom Improvement in Persons With Knee Osteoarthritis?

Atukorala, Inoshi; Makovey, Joanna; Lawler, Luke; Messier, Stephen P.; Bennell, Kim L; Hunter, David J.

doi:10.1002/acr.22805

Cited by 119 publications

(93 citation statements)

References 39 publications

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“…For the current study, we did account for the influence of weight 42 on thigh muscle strength as well as on knee pain 43 by normalizing torque to body weight. Torque was used for this purpose to attain the most appropriate scaling with body weight (mass) with Newton-meter:body weight as 1:1 26,44 .…”

Section: Discussionmentioning

confidence: 99%

Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants

Ruhdorfer

Wirth

Eckstein

2017

Osteoarthritis and Cartilage

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Objective To cross-sectionally determine the quantitative relationship of age-adjusted, sex-specific isometric knee extensor and flexor strength to patient-reported knee pain. Methods Difference of thigh muscle strength by age, and that of age-adjusted strength per unit increase on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain scale, was estimated from linear regression analysis of 4553 Osteoarthritis Initiative participants (58% women). Strata encompassing the minimal clinically important difference (MCID) in knee pain were compared to evaluate a potentially non-linear relationship between WOMAC pain levels and muscle strength. Results In Osteoarthritis Initiative participants without pain, the age-related difference in isometric knee extensor strength was −9.0%/−8.2% (women/men) per decade, and that of flexor strength was −11%/−6.9%. Differences in age-adjusted strength values for each unit of WOMAC pain (1/20) amounted to −1.9%/−1.6% for extensor and −2.5%/−1.7% for flexor strength. Differences in torque/weight for each unit of WOMAC pain ranged from −3.3 to − 2.1%. There was no indication of a non-linear relationship between pain and strength across the range of observed WOMAC values, and similar results were observed in women and men. Conclusion Each increase by 1/20 units in WOMAC pain was associated with a ~2% lower age-adjusted isometric extensor and flexor strength in either sex. As a reduction in muscle strength is known to prospectively increase symptoms in knee osteoarthritis and as pain appears to reduce thigh muscle strength, adequate therapy of pain and muscle strength is required in knee osteoarthritis patients to avoid a vicious circle of self-sustaining clinical deterioration.

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Section: Discussionmentioning

confidence: 99%

Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants

Ruhdorfer

Wirth

Eckstein

2017

Osteoarthritis and Cartilage

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“…Some differences in outcomes observed between subgroups of patients (obese vs. not obese, 65 years of age and older, not fully compliant vs. compliant) deny the existence of any substantial placebo-like effect or subordination phenomenon. Since overweight or obesity contributes to the development of knee OA and strengthens clinical symptoms of the disease [25], it seems to be expected, that our obese patients reported the greatest pain at baseline and a reduction of pain intensity during treatment not only due to being polite. In addition, were “not fully compliant” patients “subordinated”?…”

Section: Discussionmentioning

confidence: 99%

Symptom-modifying effects of oral avocado/soybean unsaponifiables in routine treatment of knee osteoarthritis in Poland. An open, prospective observational study of patients adherent to a 6-month treatment

Głuszko

Stasiek

2016

Reumatologia

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ObjectivesObservational studies provide insights into real-life situations. Therefore, we assessed the effects of oral avocado/soybean unsaponifiable (ASU) capsules on pain relief and functional ability in patients, while they were receiving a routine treatment for knee osteoarthritis (OA).Material and methodsAn open, prospective, observational 6-month study was conducted in 99 centers in Poland in a group of 4822 patients with symptomatic knee OA receiving one 300 mg ASU capsule/day as a routine medication. The patients had no diagnoses of other rheumatic diseases and were not treated with other symptomatic slow-acting drugs for osteoarthritis (SYSADOAs). Data on OA symptoms and therapy were collected from the initiation of ASU treatment (visit 0) and during 3 consecutive control visits performed every 2 months (visits 1–3). Functional Lequesne index, severity of joint pain of one symptomatic knee (Laitinen index and VAS), use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), adherence to treatment and adverse events were evaluated and recorded using electronic Case Report Forms.ResultsFour thousand one hundred and eighty-six patients (86.8%) attended all 4 visits. In 94.2% of patients (mean age 60.7 ±11.6 years SD, 73.4% female) at least one OA risk factor was identified. There was a significant improvement in functional ability between the last and baseline visits as evidenced by the median Lequesne index decreasing from 8 to 4 points (p < 0.001). Measures of pain intensity also fell significantly (p < 0.001) throughout the study: median Laitinen score decreased from 6 to 3 points, median pain at rest VAS – from 1.8 to 0 cm and median pain during walking VAS – from 5.6 to 1.9 cm. The significant differences were also noted between consecutive visits. The proportion of patients using analgesics and NSAIDs declined from 58.8% at the baseline visit to 24.9% at the last visit 3 (p < 0.001). Defined daily dose of NSAIDs decreased significantly from 1 at the baseline visit to 0.67 at the visit 3. Severe adverse events associated with ASU treatment were not observed.ConclusionsIt was the first observational study in Poland evaluating the effects of routine knee OA treatment with oral ASU. Only a small group of patients (13.2%) treated with ASU discontinued the study. The majority of patients adherent to the ASU treatment for 6 months showed gradual alleviation of joint pain, improvement in functional ability and a significant reduction in NSAIDs intake.

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“…A large-scale observational study undertaken in Australia on 1383 people (average BMI 34 kg/m 2 ) with knee OA explored the effects of an 18-week healthy weight loss programme and allowed a threshold for symptomatic benefit to be established: participants needed to achieve more than 7.7% bodyweight loss in order to achieve clinically important symptom improvement in symptoms of knee OA (Atukorala et al 2016). Just over half the participants achieved at least 7.7% weight loss.…”

Section: Formula Diets In the Management Of Other Obesity-related Co-mentioning

confidence: 99%

Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice

Brown

Leeds

2019

Nutrition Bulletin

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The role of formula very low‐energy diets (VLEDs, <800 kcal/day) and low‐energy diets (LEDs, 800–1200 kcal/day) within clinical practice has regained attention over the last few years. Formula diets can achieve clinically significant weight reduction in the short‐term (3–5 months) and new evidence demonstrates that long‐term weight loss maintenance (up to 4 years) is achievable. Weight reductions of between 10% and 15% bodyweight have been reported, which is associated with clinically meaningful health outcomes in a number of obesity‐related co‐morbidities including type 2 diabetes (T2D), obstructive sleep apnoea and osteoarthritis. Recent evidence indicates that using a formula LED with a weight loss maintenance programme can help people with overweight or obesity and T2D achieve remission. Despite this, few healthcare professionals in the UK routinely use LEDs. Concerns about adherence, risk of precipitating eating disorders, safety, cost and long‐term efficacy may, in part, contribute to their under use. To help inform healthcare professionals on the use of formula diets within clinical practice, this review examines the current evidence for the use of VLEDs and LEDs for weight loss and weight loss maintenance, and in the treatment of obesity‐related co‐morbidities, including T2D, osteoarthritis, psoriasis, obstructive sleep apnoea and secondary coronary prevention, with a particular focus on T2D remission.

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Is There a Dose‐Response Relationship Between Weight Loss and Symptom Improvement in Persons With Knee Osteoarthritis?

Cited by 119 publications

References 39 publications

Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants

Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants

Symptom-modifying effects of oral avocado/soybean unsaponifiables in routine treatment of knee osteoarthritis in Poland. An open, prospective observational study of patients adherent to a 6-month treatment

Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice

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