Review Article - International Journal of Clinical Rheumatology (2023) Volume 18, Issue 4

A realistic, randomised clinical study is being conducted to compare the effects of two low-energy diets on the symptoms of knee osteoarthritis in obese patients

Simone Appenzeller*

Department of Medicine, Faculty of Medical Science, Rheumatology Unit, Brazil

*Corresponding Author:
Simone Appenzeller
Department of Medicine, Faculty of Medical Science, Rheumatology Unit, Brazil
Received: 01-April-2023, Manuscript No. FMIJCR-23-91825; Editor assigned: 03-April-2023, Pre-QC No. FMIJCR-23-91825 (PQ); Reviewed: 17-April-2023, QC No. FMIJCR-23-91825; Revised: 22-April-2023, Manuscript No. FMIJCR-23-91825 (R); Published: 28-April-2023, DOI: 10.37532/1758-4272.2023.18 (4).66-68



To estimate in a prospective, randomized clinical trial (RCT), symptom response among fat knee osteoarthritis (OA) cases following a doable, ferocious weight- loss program for 16 weeks.


Eligible cases were fat (body mass indicator (BMI)> 30 kg/ m2);> 50 times old, with primary knee OA. Actors were randomized to either a veritably-low- energy diet (VLED) or a low- energy diet (LED) (415 kcal/ day and 810 kcal/ day, independently), using commercially available formula foods – only for the first 8 weeks, managed by dieticians. The 8 weeks were followed by a fresh 8- week period of a hypo-energetic diet conforming of normal food plus mess reserves (1200 kcal/ day). The primary endpoint was the number of cases responding according to the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT – OARSI) pollee criterion. The statistical analysis was grounded on anon-responder intention- to- treat (ITT) population (birth observation carried forward).


One hundred and ninety two cases( 155(80.7) ladies) with a mean age62.5 times( standard divagation( SD)6.4; range 50 – 78 times); average BMI37.3( SD4.8) were included. At 16 weeks, analogous proportions of the VLED and LED groups, 59(61.5), and 63(65.6) cases, independently, met the OMERACT – OARSI pollee criteria, with no statistical significant difference between the groups (P = 0.55). Combining the groups the pooled estimate was 64 meeting the pollee criteria (95 confidence interval (CI) 57, 70). There was an overall reduction in pain, corresponding to an average pain reduction on the visual analogue scale (VAS) of11.1 (95CI13.6, 8.5) in the concerted groups. At week 16 weight loss in the concerted groups was12.8 kg (95CI11.84 –13.66; P<0.001). 71 lost ≥ 10 body weight in both diet groups, with a pooled estimate of 74 (95CI 68 – 80).


No clinically significant differences were set up between the 415 kcal/ day and 810 kcal/ day diets. A 16- week formula- diet weight- loss program redounded in a fast and effective weight loss with veritably many adverse events performing in a largely significant enhancement in symptoms in fat cases with knee OA.


Knee osteoarthritis • Weight- loss • Diet • Randomized clinical trial


In osteoarthritis (OA) the knee is the most generally affected weight- bearing joint with the cardinal symptoms of pain and loss of function. Dropped mobility leading to muscle atrophy, an accelerated decline in physical function, and the incapability to engage in conditioning of diurnal living similar as walking and climbing stairs are clinical consequences that frequently lead to loss of independence and poor quality of life3. It's estimated that knee OA causes pain and functional problems in further than 10 of the population aged than 54 times, and one in four will be oppressively functionally disabled4. Pitfalls of incident OA are rotundity, generalized OA, knee malalignment and synovitis. The continuance threat of characteristic knee OA rises with adding Body Mass Index (BMI), with a threat of 2 in 3 among those who are obese6. The prevalence of rotundity is adding, and at the same time the age profile of the population changes towards aged age. This leads to an anticipated accumulation of cases having attendant OA and rotundity. OA is therefore one of numerous conditions in which rotundity must be taken into serious account for unborn healthcare planning. There's substantiation that by treating the rotundity of cases with co-occurring OA effectively, the functional status is dramatically bettered, with the short- term result equal to that of a common relief. Grounded on meta- retrogression analyses, significant weight loss is an effective symptom reducing remedy in knee OA cases with attendant rotundity. As a consequence the OARSI guidelines recommend that cases with knee OA who are fat should be encouraged to lose weight and maintain their weight at a lower position [1, 2].

As a further ferocious weight- loss strategy could affect in a more pronounced clinical effect the end of our study was to compare whether there would be an advantage in using a veritably-Low Energy Diet( VLED, 415 kcal/ day), compared to a low- energy diet( LED, 810 kcal/ day) on short- term follow up in fat cases with knee OA. The primary ideal was to compare the number of askers among fat OA cases following a doable, ferocious 16 week weight- loss program, according to the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT – OARSI) response criteria [3].

Cases and Methods

Study design

This was a prospective, realistic randomized clinical trial (RCT), with dazed outgrowth assessors the CAROTstudy (Influence of weight loss or exercise on cartilage in fat knee osteoarthritis cases a RCT, Clinical Trials. gov identifier NCT00655941.). The present report is grounded on the first trial phase of 16 weeks, initiating weight loss using salutary intervention with a LED, assessing issues at two pre-specified time- points. The primary endpoint was the number of cases responding according to the OMERACT – OARSI pollee criterion after 16 weeks of treatment [4].

Case selection

Cases were signed from November 2007 until August 2008 from the rehabilitants' clinic at the Department of Rheumatology at Frederiksberg Hospital, Frederiksberg. General interpreters in the original area were informed about the possibility to assign cases to the design. The study was announced in journals and on the website of The Parker Institute. All implicit trial actors were communicated by telephone and asked a series of standard questions according to there-specified eligibility criteria. The study was approved by the original ethical commission of The Capital Region of Denmark (H- B-2007-088) and the RCT was done according to the Helsinki criteria. The study was designed as a realistic trial – a RCT whose purpose is to inform opinions about effectiveness when used in normal practice; i.e., banning as many cases as possible from participation and being directly applicable to healthcare practitioners15. Eligibility criteria were rotundity( BMI> 30 kg/ m2); further than 50 times of age, primary knee OA diagnosed according to the American College of Rheumatology criteria16, with clinical signs and symptoms as well as radiologically or arthroscopically vindicated OA in one or both knees. Rejection criteria were former or planned total knee relief( TKA) in the target knee; surgical procedures ase.g., arthroscopy or injections into a knee within 3 months previous to registration; pharmacological remedy with weight reducing medicines; lack of provocation to lose weight; incapability to speak Danish easily; or a internal state impeding compliance with the program. Cases with other medical ails were included handed they could manage the transport to the rehabilitants' clinic on their own. No case was barred due to their medical complaint. The cases were asked not to change any nutritive supplements or OA drug during the 16- week period of the study [5, 6].


The present study showed a largely significant enhancement in symptoms in fat cases with knee OA following a 16- week intervention conforming of a LED program leading to a maturity of the actors losing further than 10 of their body weight. The positive results were demonstrated by some 60 of the actors fulfilling the OMERACT – OARSI pollee criteria for symptom enhancement at 16 weeks. The results fulfilled the prospects of a ferocious salutary program in these patients9, 11 and were analogous to the effect on OA symptoms by weight loss preliminarily shown in trials using LEDs, nutrition class or weight reducing medicines for 8 – 72 weeks10, 28, 29, 30, 31, 32, 33. Several circumstances may explain why we didn't find a difference in the weight losses between the LED and VLED groups. While overeating, individualities on both LEDs and VLEDs will show a drop in energy expenditure presumably due to a lowering of the introductory metabolic rate (BMR) and a lower physical exertion position. The reduced BMR is presumably an adaptive medium to cover the organism during starvation, and as similar it also slows the weight loss during overeating. One likely explanation as to why the VLED group didn't lose significantly further weight than the LED group is that the VLED group endured a lesser degree of fall in energy expenditure than did the LED group. Another explanation could be lower compliance in the VLED group compared with that in the LED group [7, 8]. The VLED gives only 415 kcal and a lower force of salutary protein. This could affect in further hunger and further occasions ofnon-compliance where other food is eaten, which would lead to lower weight loss in this group. Compliance with LED and VLED programs is delicate; nonetheless, it's the foundation of successful treatment.

Therefore, this trial further supports the recommendation that “cases with hipsterism and knee OA, who are fat, should be encouraged to lose weight and maintain their weight at a lower position”. The proportion of OMERACT – OARSI askers according to the Kellgren – Lawrence score of the worst cube of the knee was KL 1(71), 2(62), 3(68), 4(59), independently (n.s.). Cases with indeed oppressively affected knees( K – L grades> 3) can lose weight using this program, and have a significant relief in symptoms to the same extent as the cases with K – L grades 0 – 2, leading to the aphorism; “ bad knees are no reason for not losing weight ”. This phase of our study concentrated on the salutary intervention and it may be bandied whether a attendant exercise program might give fresh benefits. In any case, the cases showed enhancement in both ADL and sports recreation group of the KOOS scale with the topmost enhancement in ADL of the five groups, suggesting a more active life [9, 10].

Conflict of Interest





  1. Lin YJ, Anzaghe M, Schülke S et al. Update on the Path mechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells. 9, 880 (2020).
  2. Indexed at, Google Scholar, Cross ref

  3. De Cock D, Hyrich K. Malignancy and rSiegel RL, Miller KD, Jemalheumatoid arthritis: Epidemiology, risk factors and management. Best Pract Res Clin Rheumatol. 32, 869-886 (2018).
  4. Indexed at, Google Scholar, Cross ref

  5. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 320, 1360-1372 (2018).
  6. Indexed at, Google Scholar, Cross ref

  7. Kondo N, Kuroda T. Kobayashi D Cytokine Networks in the Pathogenesis of Rheumatoid Arthritis. Int J Mol Sci. 22, 10922 (2021).
  8. Indexed at, Google Scholar, Cross ref

  9. Huang J, Fu X, Chen X et al. Promising Therapeutic Targets for Treatment of Rheumatoid Arthritis. Front Immunol. 12, 686155 (2021).
  10. Indexed at, Google Scholar, Crossref

  11. Zhou S, Zou H, Chen G et al. Synthesis and Biological Activities of Chemical Drugs for the Treatment of Rheumatoid Arthritis. Top Curr Chem (Cham). 377, 28 (2019).
  12. Indexed at, Google Scholar, Cross ref

  13. Giollo A, Bissell LA, Buch MH et alCardiovascular outcomes of patients with rheumatoid arthritis prescribed disease modifying anti-rheumatic drugs: a review. Expert Opin Drug Saf. 17, 697-708 (2018).
  14. Indexed at, Google Scholar, Cross ref

  15. Dai Y, Wang W, Yu Y et al. Rheumatoid arthritis-associated interstitial lung disease: an overview of epidemiology, pathogenesis and management. Clin Rheumatol. 40, 1211-1220 (2021).
  16. Indexed at, Google Scholar, Cross ref

  17. Jegatheeswaran J, Turk M, Pope JE et al. Comparison of Janus kinase inhibitors in the treatment of rheumatoid arthritis: a systemic literature review. Immunotherapy. 11, 737-754 (2019).
  18. Indexed at, Google Scholar, Cross ref

  19. Singh JA, Tornberg H, Goodman SM et al. Pop a pill or give myself a shot? Patient perspectives of disease-modifying anti-rheumatic drug choice for rheumatoid arthritis. Joint Bone Spine. 88, 105053 (2021).
  20. Indexed at, Google Scholar, Cross ref

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