The effect of weight loss on the progression of meniscal extrusion and size in knee osteoarthritis: a post-hoc analysis of the Intensive Diet and Exercise for Arthritis (IDEA) trial.

I P Munugoda, D P Beavers, W Wirth, D A Aitken, R F Loeser, G D Miller, M Lyles, J J Carr, A Guermazi, D J Hunter, S P Messier, F Eckstein

Journal: Osteoarthritis and cartilage 2021;28(4):410-417

PMID: 32014493

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Abstract

OBJECTIVE

Weight loss has beneficial effects on clinical outcomes in knee osteoarthritis (OA), but the mechanism is still unclear. Since meniscus extrusion is associated with knee pain, this study assessed whether weight loss by diet and/or exercise is associated with less progression in meniscus extrusion measures over time.

DESIGN

The Intensive Diet and Exercise for Arthritis trial (IDEA) was a prospective, single-blind, randomized-controlled trial including overweight and obese older adults with knee pain and radiographic OA. Participants were randomized to 18-month interventions: exercise only, diet only or diet + exercise. In a random subsample of 105 participants, MRIs were obtained at baseline and follow-up. The medial and lateral menisci were segmented and quantitative position and size measures were obtained, along with semiquantitative extrusion measures. Linear and log-binomial regression were used to examine the association between change in weight and change in meniscus measures. Between-group differences were analyzed using an analysis of covariance.

RESULTS

Weight loss was associated with less progression over time of medial meniscus extrusion as measured by the maximum (β: -24.59 μm, 95%CI: -41.86, -7.33) and mean (β: -19.08 μm, 95%CI: -36.47, -1.70) extrusion distances. No relationships with weight loss were observed for lateral meniscus position, medial or lateral meniscus size or semiquantitative measures. Change in meniscus position and size did not differ significantly between groups.

CONCLUSIONS

Weight loss was associated with beneficial modifications of medial meniscus extrusion over 18 months. This may be one of the mechanisms by which weight loss translates into a clinical benefit.

CLINICAL TRIAL REGISTRATION

NCT00381290.

Address: Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia. Electronic address: [email protected].; Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. Electronic address: [email protected].; Institute of Anatomy, Department of Imaging and Functional Muskuloskelel Research; Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany. Electronic address: [email protected].; Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia. Electronic address: [email protected].; Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. Electronic address: [email protected].; Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. Electronic address: [email protected].; Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. Electronic address: [email protected].; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: [email protected].; Department of Radiology, Boston University Medical School, Boston, MA, USA; Boston Imaging Core Lab (BICL), Boston, MA, USA. Electronic address: [email protected].; Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, University of Sydney, Sydney, Australia. Electronic address: [email protected].; Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. Electronic address: [email protected].; Institute of Anatomy, Department of Imaging and Functional Muskuloskelel Research; Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany. Electronic address: [email protected].

DOI: 10.1016/j.joca.2020.01.006

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MeSH Terms: Aged, Diet, Reducing, Disease Progression, Exercise, Female, Humans, Magnetic Resonance Imaging, Male, Menisci, Tibial, Middle Aged, Obesity, Organ Size, Osteoarthritis, Knee, Overweight, Single-Blind Method, Weight Loss, Weight Reduction Programs