Reduce Weight, Reduce the Arthritic Knee Pain

Many aging Americans are both overweight and burdened by arthritis of the knees.

New research shows that shedding those excess pounds can mean shedding joint pain, too.

“This study adds to the evidence that weight loss is one of the few truly effective nonsurgical measures to reduce pain and improve function in overweight patients with knee osteoarthritis,” noted Dr. Matthew Hepinstall, a joint specialist who wasn’t involved in the new research.

“As an orthopedic surgeon treating several hundred patients per year with knee osteoarthritis, I see the detrimental effects of excess body weight on a daily basis,” said Hepinstall, associate director of the Center for Joint Preservation & Reconstruction at Lenox Hill Hospital in New York City.

It’s estimated that more than 250 million adults worldwide have knee osteoarthritis, a gradual deterioration of the joint. The new study was led by Stephen Messier of Wake Forest University and published June 18 in Arthritis Care & Research.

In earlier research, Messier’s team found that weight loss of 10 percent or more over 18 months led to a 50 percent reduction in pain and significant improvements in mobility for people with arthritic knees.

The new study found greater weight loss led to better outcomes for those overweight or obese patients with knee osteoarthritis. In analyzing the data on 240 such patients, the researchers report that a weight loss of 20 percent or more led to an additional 25 percent reduction in pain. The patients also had continued improvements in physical function, compared to people who dropped only 10 percent of their weight over the study period.

The more weight the person lost, the better they fared in terms of discomfort, overall function, the distance they were able to walk in six minutes, and their physical and mental health-related quality of life. Two measurements of knee health — joint compression force and levels of an inflammatory marker called IL-6 — also improved as patients shed excess pounds.

“A 10 percent weight loss is the established target recommended by the National Institutes of Health as an initial weight loss for overweight and obese adults,” Messier noted in a journal news release. “The importance of our study is that a weight loss of 20 percent or greater — double the previous standard — results in better clinical outcomes, and is achievable without surgical or pharmacologic intervention.”

Hepinstall acknowledged that “weight loss is easy for physicians to recommend but hard for patients to accomplish.”

He added, “This study reinforces the message that the typical results of weight loss are beneficial enough to justify the effort required in patients with knee osteoarthritis.”

HealthDay . . . . .


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New Treatment for Arthritic Knee Pain

Dennis Thompson wrote . . . . . . .

Tiny pellets could treat arthritic knee pain, delaying the need for knee replacement surgery, a small study has found.

Microparticles inserted into small blood vessels around the knee helped reduce the pain and improve function in eight arthritis sufferers, according to clinical trial results. The results were presented Monday at the Society of Interventional Radiology’s annual meeting, in Los Angeles.

“Patients overall were able to improve their physical function in the knee after the procedure, and there were no adverse events related to this treatment,” said lead researcher Dr. Sandeep Bagla.

Bagla is director of interventional radiology at the Vascular Institute of Virginia in Woodbridge. Boston Scientific, maker of the microparticles, funded the study.

Much of the pain that comes from knee arthritis actually stems from inflammation in the lining of the knee joint, also called the synovium, Bagla said. In fact, small blood vessels created by degenerative arthritis feed this inflammation by increasing blood flow to the lining.

To treat this, Bagla and his colleagues decided to try blocking those tiny blood vessels using microparticles — spheres about a tenth of a millimeter in size made from a synthetic gel-like material.

The microparticles are inserted using a catheter run through a pinhole-sized incision, in a procedure that lasts between 45 and 90 minutes, Bagla said.

“It’s an outpatient procedure, and no physical therapy is required before or after this procedure,” he said.

The small pilot study — the first U.S. clinical trial of this procedure — involved 20 patients with moderate to severe arthritis pain. Only 13 had undergone the procedure by the time of Monday’s annual meeting, and only eight had made it to the one-month follow-up, Bagla said.

Those eight patients averaged a 58-point decrease in pain, as measured on a 100-point visual scale used to estimate pain, Bagla said. They started with an average baseline of 72, which means their pain was brought down to manageable levels, he said.

Physical function of their knee also improved, based on an index used to judge the effects of osteoarthritis, Bagla added.

Overall, the two scales represented an 80 percent improvement in function, the researchers concluded.

Bagla said no side effects are expected because the procedure only blocks additional blood flow to the knee, rather than cutting it off altogether.

“You don’t normally have this degree of increased blood supply to this lining. We’re not blocking normal blood vessels to the knee or leg or bone or cartilage,” he said.

Final results from this clinical trial are expected to be released this summer. Researchers are already kicking off a second, larger trial to better understand how the procedure works and which patients it might benefit, Bagla said.

They think it will be most appropriate for people between ages 40 and 70 who aren’t ready to go through knee replacement, or people who are on chronic pain medication for their knee arthritis, Bagla said.

“Perhaps we can demonstrate and prove patients do not need to be on these medications and can alternatively go through a minimally invasive procedure like this to reduce their knee pain,” Bagla said.

Dr. Suresh Vedantham, president of the Society of Interventional Radiology, called the new procedure “very promising,” given that it focuses on the inflamed knee lining that causes the pain.

“This therapy is very well-targeted to that particular mechanism, and certainly it should be investigated further,” said Vedantham, who wasn’t involved with the study. He’s a professor of radiology and surgery at the Mallinckrodt Institute of Radiology at Washington University in St. Louis.

Research presented at medical meetings is typically considered preliminary until it is published in a peer-reviewed journal.

Source: HealthDay


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Could Fiber or Chondroitin Ease Arthritis Knee Pain?

Serena Gordon wrote . . . . .

Fiber helps lower cholesterol, stabilize blood sugar levels and keep the bowels running smoothly, but a new study suggests it can also reduce knee pain from arthritis.

Researchers found that people who ate the most fiber reported reduced osteoarthritis knee pain by up to 60 percent. However, X-rays did not show any difference in their knees compared to those who consumed less fiber.

A second study looked at the effects of the dietary supplement chondroitin on knee pain. That study — sponsored by a maker of the supplements — found that taking chondroitin daily was linked to less knee pain and improved function.

But at least two bone specialists noted that the potent type of chondroitin used in the study probably isn’t available in the United States, and the safety of long-term daily use of the supplement is unknown.

Both studies were published online in the Annals of the Rheumatic Diseases.

“With both of these studies, the danger is that people are thinking they’re making a change in their arthritis, but they may only be masking the pain. Neither study has proven a change in the natural history of osteoarthritis,” explained Dr. Victor Khabie, who was not involved with the studies. He is co-director of the Orthopedic and Spine Institute at Northern Westchester Hospital, in Mount Kisco, N.Y.

Fiber is found in fruits, vegetables, nuts and whole grains. It helps to make people feel full and reduce calorie intake. Fiber is also believed to reduce inflammation, the researchers said.

The fiber study looked at data from two other studies. One included nearly 5,000 people who had or were at risk of osteoarthritis. Their health has been monitored since at least 2006, when their average age was 61.

The second set of data came from the Framingham Offspring study, and included just over 1,200 people. That study began in 1971, and includes data from 1993 to 1994, when the average age of participants was 54. They were followed until 2002-2005.

In the first group, median fiber intake ranged from 21 grams a day to 9 grams a day. In the Framingham group, the highest group ate a median of 26 grams daily. The lowest group had nearly 14 grams daily.

People who ate the most fiber were at lower risk of developing osteoarthritis knee pain, the study found. For those in the first group who ate the most fiber, the risk went down by 30 percent. For those in the Framingham group who ate the most fiber, the risk was 61 percent less than those who ate the least fiber.

The researchers also found that people who ate more fiber were less likely to have worsening knee pain.

Lead researcher Zhaoli Dai, a postdoctoral researcher at Boston University, said, “There is a strong link among obesity, inflammation and painful knee osteoarthritis. We speculate that eating more fiber increases satiety and therefore reduces total caloric intake and reduces body weight.”

But Dai added that because the study is an observational one, it can’t prove a cause-and-effect relationship.

Dr. Matthew Hepinstall is associate director of the Lenox Hill Hospital Center for Joint Preservation & Reconstruction in New York City.

He agreed that the study cannot prove a causal relationship.

“Nevertheless, when combined with recently published data suggesting lower rates of osteoarthritis progression in patients who lose weight — also only an association — a picture is emerging that healthy lifestyles may have measurable effects on the risk of progressive osteoarthritis pain,” Hepinstall said.

But he noted that plenty of people who maintain healthy and active lifestyles also develop painful osteoarthritis. So, Hepinstall added that “a high-fiber diet should not be seen as a proven strategy for preventing arthritis.”

Dai said: “As the average intake of fiber is about 15 grams per day among Americans. This amount is way below the recommended nutritional goal according to the Dietary Guidelines for Americans 2015-2020, which recommends 22.4 grams/day for women and 28 grams/day for men aged 51 years and above.”

According to the Dietary Guidelines for Americans 2015-2020, a usual serving of high-fiber cereal contains 9 or more grams of fiber. A cup of navy beans provides nearly 10 grams, and an apple has about 5 grams of fiber.

The second study looked at chondroitin sulfate. It’s a chemical found naturally in the cartilage of the knee, according to the U.S. National Library of Medicine.

The study included more than 600 people from five European countries who had been diagnosed with knee osteoarthritis. The patients were randomly assigned to one of three treatment groups.

One group was given 800 milligrams (mg) of “pharmaceutical grade” chondroitin daily and one placebo pill to mimic 200 mg of the pain reliever celecoxib (Celebrex). Another group was given a 200-mg celecoxib pill and a placebo to mimic the chondroitin pill. The third group was given two placebo pills.

The study lasted six months. Doctors assessed the study participants at one, three and six months.

Reductions in pain and improvements in joint function were greater in people treated with chondroitin or celecoxib at three and six months. The researchers said that chondroitin provided similar relief to celecoxib.

Khabie said, “It looks like there’s an anti-inflammatory or pain-relieving effect when chondroitin is taken in a very purified, very well-controlled state, but that’s probably not what’s available off-the-shelf [in the United States].” He noted that chondroitin is a supplement, and in the United States supplements aren’t regulated in the same way that drugs are.

Khabie also said that the safety of taking chondroitin long-term isn’t known.

Hepinstall echoed Khabie’s concerns about the chondroitin study, but also said chondroitin might be “particularly well-suited for patients who cannot take NSAID medications.” NSAIDs, or non-steroidal anti-inflammatory drugs, include ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin.

Source: HealthDay


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