November 10-15

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ACR Convergence 2023

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Losing weight proven to improve osteoarthritis management


3 minutes

Stephen P. Messier, PhD
Stephen P. Messier, PhD

Osteoarthritis (OA) remains one of the most persistent dilemmas in rheumatology. With no cure for the disease, the focus has turned to management. The persistent question is, which management strategies are most effective for which patients?

“Because we have yet to find a cure for OA, what has become most important is what’s best for the patient,” said Stephen P. Messier, PhD, Professor and Director of the J.B. Snow Biomechanics Laboratory at Wake Forest University. “That is generally a decrease in pain, improvement in function, and quality of life. With no cure in sight, research has focused on symptom management.”

Dr. Messier will launch a symposium covering the latest developments. During OA Management: Non-Pharmacologic, Pharmacologic & Controversial Approaches from 4:30 – 6 :00 pm Monday in Room W190a, he will discuss the latest finding in nonpharmacologic management of OA.

Joel A. Block, MD, the Willard L.Wood, MD Professor of Rheumatology, Professor Medicine and of Biochemistry and Director of Rheumatology at Rush University Medical Center, will discuss the latest in pharmacologic management of OA.

Jeffrey N. Katz, MD, Professor of Rheumatology and Orthopedic Surgery at Harvard Medical School, will discuss some of the more controversial approaches to managing OA, including efficacy and safety profiles of intra-articular hyaluronic acid, platelet-rich plasma, stem cells, and arthroscopic surgery.

Regardless of the management approach, OA remains the leading cause of disability in older adults. In the lower extremities, OA most commonly affects the knee, and thus has a detrimental effect on gait and other activities of daily living, Dr. Messier said.

Pharmacologic management works for some patients, he said. Half of the patients using non-steroidal anti-inflammatory agents can expect approximately a 30 percent reduction in pain. Non-pharmacologic approaches, specifically weight loss plus moderate exercise, can reduce pain by 30 to 50 percent.

“The answer is probably a cocktail that combines pharmacologic and nonpharmacologic interventions to give you the best clinical outcomes,” Dr. Messier said.

Studies he has completed show a direct relationship between weight loss plus exercise and reduction in pain from OA. He has examined clinical outcomes, mechanistic outcomes, and structural outcomes.

Clinical outcomes include pain, function, and mobility. Structural outcomes include inflammation and joint loads. Structural outcomes include physical changes in joints as seen by x-ray, MRI, and other imaging techniques.

“The combination of 10 percent weight loss and moderate exercise is probably the best treatment for people who are overweight or obese and have knee OA,” Dr. Messier said.

Initial trials comparing the effects of five percent weight loss plus moderate exercise versus exercise and weight loss alone showed a clear win for combination treatment. Five percent weight loss plus exercise provided a 30 percent reduction in pain.

Doubling the weight loss to 10 percent, plus moderate exercise, produced a 50 percent reduction in pain as reported by patients.

“Ten percent weight loss gave us statistically and clinically significant improvements in outcomes,” Dr. Messier said. “The mechanistic outcomes, inflammation and mechanical loading on the knee, were reduced significantly. We think it was the combination of reduced inflammation and reduced joint loading that was instrumental in pain reduction.”

A small cohort in the study lost more than 20 percent of their original weight and showed significant improvements in clinical outcomes compared to less weight loss.

However, Dr. Messier noted, “At the same time, losing 20 percent of your body weight is a formidable task for most people. We recommend losing 10 percent of original body weight plus moderate exercise, but if patients want to continue losing weight safely after they reach that 10 percent goal, they will see additional benefits. People almost everywhere are living longer, and our goal is to improve their quality of life during these later years.”