Patients with pro-inflammatory diet report worse knee osteoarthritis pain
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Key takeaways:
- Diets rich in fats, oils and sweets were associated with worse pain, but not to changes in knee structure.
- Diet can be part of a comprehensive approach to manage osteoarthritis pain, researchers said.
Patients with pro-inflammatory diets demonstrate worse knee osteoarthritis pain and a greater risk for 10-year severe pain trajectory, according to data published in Arthritis Care & Research.
“The absence of drugs that can slow or reverse the progression of osteoarthritis and the challenges in effectively managing pain through analgesics have prompted the identification of factors that can be modified to address osteoarthritis progression and symptoms, such as pain,” Feng Pan, PhD, of the Menzies Institute for Medical Research at the University of Tasmania, in Australia, told Healio. “The dietary inflammatory index serves as a valuable tool, assessing an individual’s overall dietary pattern and its potential influence on inflammation, which is considered an important factor in the progression and pathology of osteoarthritis.”
To examine the relationship between OA pain Dietary Inflammatory Index (DII) score, Pan and colleagues analyzed data from the prospective, population-based Tasmanian Older Adult Cohort study. The cohort includes 1,099 patients who completed assessments at baseline, 875 who completed assessments at 2.6 years, 768 who completed assessments at 5.1 years, and 566 participants who completed assessments at 10.7 years.
Participants underwent T1-weighted and T2-weighted MRI to measure cartilage volume and bone marrow lesions at baseline and 10.7years. Meanwhile, their pain levels and pain trajectories — defined as minimal, mild or moderate pain — were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain questionnaire. Baseline energy-adjusted DII (E-DII) scores were also calculated.
According to the researchers, higher DII scores are associated with a greater intake of fats, oils, sweets and sodas, meat, fish, poultry, beans and eggs, and with a lower intake of whole grains, fruits, and vegetables.
In all, the researchers included 944 patients with complete DII score, WOMAC pain score, and covariate data in the pain analyses, as well as 407 patients with complete DII score, MRI, and covariate data — at baseline and 10.7years —in the analyses of knee structural changes.
In multivariable analyses, E-DII scores were positively associated with pain scores, as well as greater risk for being classified into the “moderate pain” trajectory group, compared with “minimal pain,” according to the researchers. However, there was no association with tibial cartilage volume loss, and E-DII score was only linked to size increases in medial tibial bone marrow lesions (RR = 0.86; 95% CI, 0.75-0.98).
According to Pan, the lack of association between E-DII score and overall structural changes in the knee was “unexpected.”
“The exact reason for this is unknown, but it could be indicative of distinctions in the role of inflammatory responses concerning structural changes and pain signals in the joint,” he said.
“Our research revealed that higher dietary inflammatory index scores were linked to increased pain severity and a worse pain course,” Pan added. “These findings highlight the potential of dietary modification, specifically the adoption of anti-inflammatory diets, in a comprehensive approach to effectively manage pain associated with knee osteoarthritis.”
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
Patients are always asking, “What diet should I be on for my inflammatory arthritis?” In recent decades, the body of literature exploring the connection between inflammation and health has expanded significantly. Alongside this surge, there has been a heightened emphasis on understanding how diet influences inflammation, evidenced by a doubling in research output approximately every 4 years.
The creation of the Dietary Inflammatory Index (DII) offers a quantitative tool for evaluating the impact of dietary choices on various health outcomes, spanning from inflammatory cytokine levels in the blood to the development of chronic diseases. In 2021, an umbrella review demonstrated the significant role of anti-inflammatory dietary patterns in preventing chronic diseases.
Numerous studies have investigated the correlations between DII scores and different diseases, demonstrating that elevated scores are associated with heightened risks for cancer, cardiovascular disease and osteoporosis with fractures. High DII scores are linked to a higher prevalence of radiographic symptomatic knee osteoarthritis and knee pain.
The “healthy eater” effect, exemplified by the intentional choice of nutrient-dense, energy-sparse foods by health-conscious individuals, is well-documented. Conversely, its counterpart, the “unhealthy eater” effect, characterized by a preference for energy-dense, nutrient-sparse foods, is increasingly prevalent globally. We are getting the answer to our patients’ question about diet and inflammatory arthritis.
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