by Robert J. Snyder, MD
One day, when you are getting up from a chair, you feel it…that stiffness and soreness in your knee. You try to ignore it, but soon, your knee pain becomes a part of your daily life. So, you start taking an over-the-counter pain reliever, using muscle rubs and cut back on your exercise routine a bit, hoping that your knee pain will go away. After a while, your knee pain becomes a real distraction and prevents you from participating in the activities that you enjoy. You decide to go and see your family doctor and are referred to an orthopaedic specialist. After a complete examination and a set of knee x-rays, you are told you have osteoarthritis in your knee, causing the pain and stiffness. Your orthopaedist gives you a prescription for a strong anti-inflammatory drug, advises that you drop that extra weight you are carrying and gives you a referral for Physical Therapy to strengthen the weak muscles that support your knee. Now, which of these doctor’s orders are you most likely to follow?
Unfortunately, most of the patients that I see choose the medication first, the Physical Therapy second and almost never choose to lose weight as a treatment for their arthritis pain.
Perhaps, as physicians, we do not do a good enough job educating patients about the benefits of losing weight as a first step in the battle against arthritis pain. We may rely too heavily on medications to treat our patient’s pain, because we know that most patients just will not get serious about weight loss. Whatever the reasons, weight-loss should be emphasized as one of the FIRST options for arthritis treatment of the knee. Let me explain why.
The joints are the mechanical “work-horses” of the body, continually moving, twisting and bending. The joints that bear the weight of the body (the knees, the hips, the ankles) have it especially hard. The knees, in particular, seem to wear out much faster than other joints, because of their stress load throughout a person’s life. Carrying extra weight makes that job even more difficult for the knees and over time, they will start complaining by developing arthritis.
Do people who are considered normal weight or underweight develop knee arthritis? Of course, they do. But let me give you some startling statistics from the Centers for Disease Control and Prevention’s (CDC) website…
• Between 1980 and 2010, obesity rates among adults in the US doubled
• 36% of the US population is now considered obese
o An adult who has a BMI between 25 and 29.9 is considered overweight
o An adult who has a BMI of 30 or higher is considered obese
• Obesity rates are 54% higher among adults with arthritis, compared to those without the condition
• 1 in 3 obese adults have arthritis
• Obesity is associated with incident knee osteoarthritis (OA), disease progression, disability, total joint replacement, and poor clinical outcomes after joint replacement and likely has a critical role in the increasing population burden and impact of arthritis
Even so, people rarely choose to lose weight as a treatment for arthritis, perhaps because they feel they have too much to lose to make a difference in the amount of pain that they feel. However, let me share a hopeful statistic with you from the CDC:
o Even small amounts of weight loss (approximately 11 lbs) may cut the risk of getting knee osteoarthritis by 50% and may reduce mortality risk in patients with osteoarthritis
If that doesn’t give you enough encouragement, please consider the findings of this study, published in the journal Arthritis & Rheumatism:
• Researchers at Wake Forest University in Winston-Salem, North Carolina found that for overweight or obese adults with osteoarthritis of the knee, losing a single pound could result in a 4 lb reduction in pressure placed on the knee joint. “Our results indicate that each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities,” wrote lead researcher Dr. Stephen P. Messier and colleagues. “Accumulated over thousands of steps per day, a reduction of this magnitude would appear to be clinically meaningful.”
When faced with evidence of the correlation between obesity and arthritis AND the evidence that losing weight plays a big part in positively treating arthritis pain, you would think every patient of mine would choose losing weight over taking medication, getting injections into their knee or finally having knee replacement surgery. That is not to say that if everyone lost weight, they would never have to have a knee replacement. However, losing weight may delay a person’s having to have surgery and may provide for much less pain and discomfort doing their daily activities.
While modern scientific technology has allowed researchers to develop effective medications for treating arthritis and surgeons are able to implant new knees in patients with severe knee arthritis, perhaps the act of losing weight could be the most effective treatment available today for arthritis of the knee.
Robert J. Snyder, MD is a board-certified orthopaedic specialist at Orthopaedic and Spine Center in Newport News, VA. For more information or to make an appointment, call 757-596-1900.
by Robert J. Snyder, MD