EFFECT OF A MULTIDISCIPLINARY LIFESTYLE PROGRAM ON PATIENTS WITH METABOLIC SYNDROME-ASSOCIATED OSTEOARTHRITIS: THE PLANTS FOR JOINTS RANDOMIZED CONTROLLED TRIAL

BackgroundMetabolic syndrome with low grade inflammation is associated with chronic diseases including osteoarthritis (OA) (1). Nonpharmacological treatment with a combination of an intensive diet and exercise produced better results in people with osteoarthritis (OA) than either treatment alone (2). We further developed the concept of an integrated lifestyle intervention in people with metabolic syndrome-associated osteoarthritis (MSOA) by combining a whole food plant-based diet with physical activity and stress management.ObjectivesTo determine the effect of a multidisciplinary lifestyle program on pain, stiffness, and physical function in patients with MSOA.MethodsIn the “Plants for Joints” (PFJ) parallel-arm, randomized clinical trial, patients with MSOA were assigned to the PFJ group or the control group. Patients with metabolic syndrome (according to NCEP criteria) and OA in the knee and/or hip (according to clinical ACR criteria) were eligible for participation. The PFJ group followed a 16-week lifestyle program based on a whole food plant-based diet, physical activity, and stress management in addition to usual care. The control group received usual care.Prior to the start of the study, it was hypothesized that the lifestyle program would lower pain and stiffness and improve physical function, based on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (primary outcome). Secondary outcomes included anthropometric, and metabolic markers. Patient partners selected the patient-reported outcome measures (PROMIS©) depression, fatigue, pain interference and physical function as additional secondary outcomes.An intention-to-treat analysis with a linear mixed model, adjusted for baseline values (and age, sex, and body mass index [BMI] in additional analyses), was used to analyze the between-group differences of continuous outcomes.ResultsOf the 92 people screened, 66 were randomized and 64 completed the study (PFJ group: n = 32). Participants were 84% female, had a mean (SD) age of 63 (6) and a mean (SD) BMI of 33 (5) kg/m2. After 16 weeks the PFJ group had a mean 11-point greater improvement of the total WOMAC score (range 0-96) over time (95% CI 6 to 16; p = 0.0001) with significant improvements in all three components pain, stiffness, and physical function compared to the control group (Figure 1). Also, compared to the control group, the PFJ group lost more body weight (–3.9 kg, 95% CI –5.8 to –2.0; p < 0.001), fat mass as measured with dual-energy x-ray absorptiometry (–3.9 kg, 95% CI –5.3 to –2.5; p < 0.0001) and waist circumference (–4 cm, 95% CI –7 to –1; p = 0.01). HbA1c and fasting glucose improved in the PFJ versus control group, but not significantly. LDL decreased by 0.38 mmol/l (95% CI 0.07 to 0.69; p = 0.02) and triglycerides by 0.32 (95% CI 0.01 to 0.63; p = 0.04) in favour of the PFJ group. HDL and blood pressure remained unchanged. Of the patient reported outcome measures (PROMIS©) only fatigue showed a significant improvement. Based on a baseline mean (SD) value of 55 for all the participants, fatigue improved with 4 (95% CI 1 to 6; p = 0.03) in the PFJ group when compared with the control group. Additional analyses adjusted for age, sex, and BMI did not lead to different outcomes.No serious adverse events occurred.ConclusionThe 16-week “Plants for Joints” lifestyle program substantially decreased pain and stiffness and improved physical function in people with metabolic syndrome associated osteoarthritis of hip and/or knee. In addition, following the lifestyle program resulted in lower weight, fat mass and smaller waist circumference in comparison with usual care.References[1]Furman D et al. Chronic inflammation in the etiology of disease across the life span. Nat Med. 2019;25(12):1822-32.[2]Messier SP et al. Effects of intensive diet & exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee OA. JAMA. 2013;310(12):1263-73.Disclosure of InterestsWendy Walrabenstein: None declared, Carlijn Wagenaar: None declared, Marike van der Leeden: None declared, Martijn Gerritsen Grant/research support from: Menarini, Grunenthal and Horizon Pharma, Martin van der Esch: None declared, Dirkjan van Schaardenburg: None declared