Health chats with Dr.Leeds | Prof Henning Bliddal, Director, Parker Institute, Copenhagen, Denmark
The number of people with osteoarthritis is increasing because we have ageing populations that are heavier than in the past. There is currently no medication or other intervention proven to slow the disease process. We treat the pain and inflammation until the joint is so badly damaged that surgical joint replacement, total or partial, becomes necessary. Weight reduction is a core feature of osteoarthritis guidelines but is difficult to achieve in those with limited mobility.
Osteoarthritis is a type of damage and inflammation in joints in which the joint cartilage is progressively damaged and nearby bone thickens. Typically, it occurs in middle or old age and causes stiffness, swelling, pain, reduced movement and deformation of the joints. It commonly affects load bearing joints (hips and knees) but can affect all joints of the body. Heavier people are more likely to get osteoarthritis and losing weight has long been known to reduce pain and improve mobility. However, losing enough weight and maintaining that weight loss can be challenging.
In this conversation Professor Henning Bliddal, Director of the Parker Institute, the arthritis institute at Frederiksberg hospital in Copenhagen describes the work of his team in undertaking an effective weight loss study in people with knee osteoarthritis. The team recruited obese people with knee osteoarthritis for weight reduction with a formula diet programme followed by four years of weight maintenance. Average weight loss at the end of 4 months was about 12 kg, most of which was maintained at one year. Four years later the average weight loss maintenance was about 10kg.
Furthermore, reduction of symptom scores and reduced blood pressure were maintained, demonstrating the effectiveness of such a programme on other co-morbidities associated with knee osteoarthritis. Joint pain was reduced, and that reduction was largely maintained for four years. Magnetic resonance imaging studies on some of the participants showed that inflammation in the fat pad under the knee-cap and membrane around the joint was related to the severity of knee pain, suggesting that reduction of inflammation associated with weight loss is the mechanism that results in pain reduction. A further recent study on many hundreds of blood proteins has shown that weight loss, however it is achieved, reduces inflammation in the body.
The formula 800kcal/d diet used in Copenhagen was composed of nutritionally complete soups and shakes formulated to provide all needed vitamins, minerals, essential fats and protein. That type of diet usually results in 1–2kg weight loss weekly with metabolic improvement in glucose, insulin, blood lipids and blood pressure in people with pre-diabetes, early diabetes, advanced diabetes, osteoarthritis, psoriasis, obstructive sleep apnoea, and heart disease.
Prof Bliddal describes how this remarkable outcome was achieved and the challenges in getting this type of intervention into routine practice. The importance of the need for weight loss is widely acknowledged but how to achieve this effectively is rarely described.
Alongside losing weight, people with osteoarthritis need to do muscle strengthening exercises, keep as active as possible, check with their doctor that their medication is the best choice for them, and some may benefit from special insoles in their shoes or other forms of physical support to improve the way they walk.
Web links to useful sources of information are given below.
Information about osteoarthritis for the UK
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