Systematic review1Pooled analysis of weight loss trials in knee arthritis
Who and when. Researchers at the Parker Institute in Copenhagen, published in the Annals of the Rheumatic Diseases in 2007.
What they did. They searched for randomised trials where the only difference between groups was a weight loss programme, and pooled the four they found, with 454 people.
What they found. People lost about 6 kg on average. Pain and physical function improved by a small amount. Looking across the trials, function improved most when people lost more than 5 percent of their body weight, at a steady rate of about a quarter of a percent a week.
What it means. Losing weight helps, and the amount lost makes a difference. This review is older and small, which is one reason the grade is probably helps a little.
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis. A systematic review and meta-analysis. Ann Rheum Dis. 2007;66(4):433-439.
Read the summary on PubMed →
Randomised trial2The IDEA trial of diet and exercise for knee arthritis
Who and when. Wake Forest University in the United States, published in JAMA in 2013.
What they did. They randomly assigned 454 overweight or obese adults aged 55 and over with knee arthritis to an intensive diet, an exercise programme, or both, and followed them for 18 months. The aim was a 10 percent loss of body weight.
What they found. People doing diet and exercise together lost 10.6 kg on average, the diet-only group 8.9 kg and the exercise-only group 1.8 kg. The diet and exercise group had less pain, better function and better quality of life than either of the other groups. Load through the knee and a blood marker of inflammation both fell in the diet groups. Nearly 4 in 10 of the diet and exercise group had little or no pain at 18 months.
What it means. Diet and exercise together work better than either alone, and a 10 percent weight loss was safe and possible for older adults with support.
Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, Beavers DP, Hunter DJ, Lyles MF, Eckstein F, Williamson JD, Carr JJ, Guermazi A, Loeser RF. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis. The IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273.
Read the summary on PubMed →
Australian guideline3RACGP guideline for knee and hip osteoarthritis
Who and when. The Royal Australian College of General Practitioners, with Australian arthritis researchers, second edition 2018. This is the guideline Australian GPs follow.
What they did. An expert panel reviewed the research on each treatment and graded how strongly to recommend it, for or against.
What they found. Weight management is strongly recommended for people with knee or hip arthritis who are overweight or obese, alongside exercise. The guideline suggests aiming for at least 5 to 7.5 percent of body weight.
What it means. Australian GPs are advised to raise weight as part of every arthritis plan, with a target in line with the trials above.
Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd ed. East Melbourne: RACGP; 2018.
Read the guideline →
International guideline4OARSI guideline for non-surgical treatment of knee and hip osteoarthritis
Who and when. The Osteoarthritis Research Society International, the main scientific body for arthritis research, published July 2019.
What they did. A panel of 21 experts from 11 countries reviewed the pooled trial evidence for 60 different treatments and voted on each one.
What they found. Weight management was named a core treatment for knee arthritis, together with education and exercise, for everyone who is overweight.
What it means. Core means it should be offered to everyone it applies to, not held back for severe cases.
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589.
Read the summary on PubMed →
US guideline5American College of Rheumatology guideline for osteoarthritis
Who and when. The American College of Rheumatology and the Arthritis Foundation, published January 2020. The panel included patients as well as doctors and therapists.
What they did. A literature review team summarised the benefits and harms of every common treatment, and a voting panel graded each recommendation as strong or conditional.
What they found. Weight loss received a strong recommendation for people with knee or hip arthritis who are overweight or obese. The panel noted that the benefit grows with the amount lost.
What it means. A strong recommendation means the panel was confident the benefit clearly outweighs any harm.
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220-233.
Read the summary on PubMed →