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Randomized Controlled Trial
. 2015 Jul;23(7):1090-8.
doi: 10.1016/j.joca.2015.03.034. Epub 2015 Apr 15.

The Intensive Diet and Exercise for Arthritis (IDEA) trial: 18-month radiographic and MRI outcomes

D J Hunter  1 , D P Beavers  2 , F Eckstein  3 , A Guermazi  4 , R F Loeser  5 , B J Nicklas  6 , S L Mihalko  7 , G D Miller  8 , M Lyles  9 , P DeVita  10 , C Legault  2 , J J Carr  11 , J D Williamson  9 , S P Messier  12
Affiliations
Randomized Controlled Trial

The Intensive Diet and Exercise for Arthritis (IDEA) trial: 18-month radiographic and MRI outcomes

D J Hunter et al. Osteoarthritis Cartilage. 2015 Jul.

Abstract

Purpose: Report the radiographic and magnetic resonance imaging (MRI) structural outcomes of an 18-month study of diet-induced weight loss, with or without exercise, compared to exercise alone in older, overweight and obese adults with symptomatic knee osteoarthritis (OA).

Methods: Prospective, single-blind, randomized controlled trial that enrolled 454 overweight and obese (body mass index, BMI = 27-41 kg m(-2)) older (age ≥ 55 yrs) adults with knee pain and radiographic evidence of femorotibial OA. Participants were randomized to one of three 18-month interventions: diet-induced weight loss only (D); diet-induced weight loss plus exercise (D + E); or exercise-only control (E). X-rays (N = 325) and MRIs (N = 105) were acquired at baseline and 18 months follow-up. X-ray and MRI (cartilage thickness and semi-quantitative (SQ)) results were analyzed to compare change between groups at 18-month follow-up using analysis of covariance (ANCOVA) adjusted for baseline values, baseline BMI, and gender.

Results: Mean baseline descriptive characteristics of the cohort included: age, 65.6 yrs; BMI 33.6 kg m(-2); 72% female; 81% white. There was no significant difference between groups in joint space width (JSW) loss; D -0.07 (SE 0.22) mm, D + E -0.27 (SE 0.22) mm and E -0.16 (SE 0.24) mm (P = 0.79). There was also no significant difference in MRI cartilage loss between groups; D -0.10(0.05) mm, D + E -0.13(0.04) mm and E -0.05(0.04) mm (P = 0.42).

Conclusion: Despite the potent effects of weight loss in this study on symptoms as well as mechanistic outcomes (such as joint compressive force and markers of inflammation), there was no statistically significant difference between the three active interventions on the rate of structural progression either on X-ray or MRI over 18-months.

Keywords: MRI; Osteoarthritis; Weight loss; X-ray.

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Conflict of interest statement

Competing interest

AG is President of Boston Imaging Core Lab, LLC and Consultant to Sanofi-Aventis, Merck Serono and TissueGene.

FE is co-owner, CEO and CMO of Chondrometrics GmbH and Consultant to MerckSerono and Abbvie.

Figures

Fig. 1.
Fig. 1.
Landmarks and definition of coordinate system.
Fig. 2.
Fig. 2.
(a) Sagittal magnetic resonance images (MRI) acquired using SPGR sequence. Both images depict the same slice of the MFTC. The image on the right shows the segmentation of the cartilage (magenta = segmentation of the cartilage surface; green = segmentation of the total area of subchondral bone = tAB) and the filling between the two surfaces in turquoise. The image of the MFTC shows an area of denuded subchondral bone (dAB) in the weight-bearing aspect of the medial femoral condyle (cMF) and medial tibia (MT). (b) Visual display of the medial femorotibial subregions. Posterior view of the femorotibial compartment of the knee (middle), inferior view of the weight-bearing femur (top), and superior view of the tibia (bottom). Color codes for both the femoral and tibial plates: red = central subregion, green = external subregion, blue = internal subregion, yellow = posterior subregion, turqoise = anterior subregion.
Fig. 3.
Fig. 3.
Percent changes from baseline (95% CI) for mJSW and MTFC thickness.
See this image and copyright information in PMC

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