Much less is known about the role of diet in the treatment of OA and other degenerative arthritides. The above discussion regarding n-3 PUFAs in RA also may pertain to OA, although the strength of the effect has not been studied as thoroughly. However, the same eicosanoid metabolism occurs in OA as in RA, with the exception that the disorder is limited to the joint rather than involving the whole body. Thus, fish oils may well be of benefit in OA. Antioxidant intervention with vitamin E may also be effective in OA, with several studies showing an effect comparable with NSAIDs. Although not strictly nutrients, glucosa-mine and chondroitin sulfate, which are two of the constituents of normal cartilage that decline with arthritis, have been shown to be useful when given as an oral supplement, especially in patients with early OA.
In contrast to RA, where diet's main role is in the treatment and little is known about prevention, there is more known about dietary components that lead to OA than about nutritional management of OA. It is clear that OA of the lower extremities is largely a problem brought on by obesity, especially OA of the knee (and hip, to a much lesser extent), suggesting that obesity seems to be a mechanical rather than systemic risk factor. Thus, maintaining body weight within the recommended ranges is probably the most important nutritional intervention to prevent OA. Weight loss leads to reduction in joint stress, and often reduces symptoms. In fact, recent studies have suggested that if all overweight and obese individuals reduced their body weight by 5 kg, or until their body mass index (BMI) was within the desirable range, 24% of surgeries for knee OA could be avoided. Furthermore, studies have demonstrated that exercise can improve OA symptoms even independently of weight loss, presumably by increasing muscle strength and thus improving the shock-absorbing power of the muscles, hence sparing the cartilage and joint. However, patients with OA have a great deal of difficulty with exercise, and their sedentary life style is reinforced by their joint pain, generally leading to weight gain after the onset of OA, which in turn exacerbates the disease, creating a vicious cycle. Exercise programs that increase physical activity and strengthen the muscles surrounding afflicted joints clearly improve symptoms in OA. Thus, OA can be thought of as a disease of overnutrition, while RA is generally a disease of undernutrition. Interestingly, recent twin studies have examined the role of genetic versus environmental factors as mediators of the obesity-OA relationship, and have suggested that shared genetic factors are not as important as environmental factors in mediating the obesity-OA relationship. Dietary modification leading to weight loss is a critical component of the management of OA.
See also: Cytokines. Fatty Acids: Omega-3 Polyunsaturated. Obesity: Complications. Starvation and Fasting. Supplementation: Dietary Supplements; Role of Micronutrient Supplementation. Vegetarian Diets.
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