Small weight loss better than drugs for improving OA pain, stiffness, function

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Small weight loss better than drugs for improving OA pain, stiffness,

function



Nov 15, 2005



Janis



" A 15-pound weight loss reduced pain by 40%, improved function by

50%, and reduced stiffness by 48%. "

San Diego, CA - Losing even a small amount of weight can reduce pain,

relieve stiffness, and improve daily functioning for patients with

mild to moderate knee osteoarthritis (OA), in some cases more

effectively than a coxib, Dr J Bartlett (s Hopkins Medical

Institutions, Baltimore, MD) reported at the 2005 ACR/ARHP Annual

Scientific Meeting [1].

" A 15-pound weight loss reduced pain by 40%, improved function by

50%, and reduced stiffness by 48%. This compares favorably with the

28% improvement in function seen with drugs such as celecoxib or

rofecoxib, " said Bartlett.

15 pounds lost in 16 weeks with a bit of walking each day

The weight-loss intervention included classes on nutrition, physical

activity, behavior, and attitudes. Bartlett described the exercise

component as " lifestyle walking. " Participants wore pedometers and

gradually built up to 10 000 steps per day on most or all days of the

week. The subjects in this study were 48 significantly overweight

adults, all of whom met the American College of Rheumatology criteria

for knee OA. At baseline, the mean weight of the 38 female subjects

was 90.7 kg and of the 10 males was 101.9 kg. All had pain in one or

both knees on more than half the days of each month and had

difficulty with activities of daily living.

The investigators randomized the subjects to receive immediate or

delayed intervention, and the delayed-intervention group served as

controls.

The average weight lost by those in the immediate-intervention

(weight-loss) group was 6.8 kg and 0.4 kg by those in the control

group (p<0.001). " In 16 weeks, the typical participant lost an

average of 15 pounds, " Bartlett said. " For the average 5'4 " woman who

weighed 200 pounds at baseline, that meant a weight loss to 185

pounds. This might not seem like much, but we observed that even

losing this modest amount of weight made a big difference, " Bartlett

said.

Mean change from baseline after 16 weeks of walking and weight loss

education

Variable

Weight-loss group

Control group

p

Change from baseline weight (kg)

-6.9

+0.4

<0.001

WOMAC pain score

-39.7

+1.4

0.003

Stiffness

-45.1

+1.4

0.001

Function

-49.0

-0.5

0.001

Total score

-48.9

-1.4

<0.001

Interestingly, in males, the improvements in stiffness, functioning,

and total Western Ontario and McMaster University (WOMAC)

Osteoarthritis Index score were highly associated with percentage of

weight loss, and there were strong associations with both absolute

fat loss and percentage of fat loss. In females, the improvements in

pain, stiffness, functioning, and total WOMAC score were not

significantly associated with absolute weight loss, percentage of

weight loss, absolute fat loss, or percentage of fat loss.

Bartlett speculated that there may be psychological differences, such

that even a small weight loss in women helped them feel better.

That major improvement in symptoms and function were associated with

a relatively small weight loss suggests that the benefits might not

be the result of a simple reduction in the weight burden on the OA

knee. Increasing attention is being paid to the role of adipose

tissues in inflammation. Dr TH Yeh (University of Texas-

Houston Health Science Center) and colleagues reported earlier this

year that human fat cells produce the inflammatory mediator C-

reactive protein (CRP) [2].

Bartlett tells rheumawire that her group has examined the

relationship between weight loss, symptom improvement, and changes in

inflammatory mediators such as CRP in patients with knee OA and will

be reporting " intriguing data " in December.

http://www.jointandbone.org/viewArticle.do?primaryKey=601523