From Jointandbone.org, by Janis Kelly.

San Diego, CA - Losing even a small amount of weight can reduce pain, relieve stiffness, and improve daily functioning for patients with mild to moderate knee osteoarthritis (OA), in some cases more effectively than a coxib, Dr Susan J Bartlett (Johns Hopkins Medical Institutions, Baltimore, MD) reported at the 2005 ACR/ARHP Annual Scientific Meeting [1].
"A 15-pound weight loss reduced pain by 40%, improved function by 50%, and reduced stiffness by 48%. This compares favorably with the 28% improvement in function seen with drugs such as celecoxib or rofecoxib," said Bartlett.

The weight-loss intervention included classes on nutrition, physical activity, behavior, and attitudes. Bartlett described the exercise component as "lifestyle walking." Participants wore pedometers and gradually built up to 10 000 steps per day on most or all days of the week. The subjects in this study were 48 significantly overweight adults, all of whom met the American College of Rheumatology criteria for knee OA. At baseline, the mean weight of the 38 female subjects was 90.7 kg and of the 10 males was 101.9 kg. All had pain in one or both knees on more than half the days of each month and had difficulty with activities of daily living.
The investigators randomized the subjects to receive immediate or delayed intervention, and the delayed-intervention group served as controls.
The average weight lost by those in the immediate-intervention (weight-loss) group was 6.8 kg and 0.4 kg by those in the control group (p<0.001).>

Interestingly, in males, the improvements in stiffness, functioning, and total Western Ontario and McMaster University (WOMAC) Osteoarthritis Index score were highly associated with percentage of weight loss, and there were strong associations with both absolute fat loss and percentage of fat loss. In females, the improvements in pain, stiffness, functioning, and total WOMAC score were not significantly associated with absolute weight loss, percentage of weight loss, absolute fat loss, or percentage of fat loss.
Bartlett speculated that there may be psychological differences, such that even a small weight loss in women helped them feel better.
That major improvement in symptoms and function were associated with a relatively small weight loss suggests that the benefits might not be the result of a simple reduction in the weight burden on the OA knee. Increasing attention is being paid to the role of adipose tissues in inflammation. Dr Edward TH Yeh (University of Texas-Houston Health Science Center) and colleagues reported earlier this year that human fat cells produce the inflammatory mediator C-reactive protein (CRP) [2].
Bartlett tells rheumawire that her group has examined the relationship between weight loss, symptom improvement, and changes in inflammatory mediators such as CRP in patients with knee OA and will be reporting "intriguing data" in December.

Adalimumab Plus Methotrexate Superior to Monotherapy for RA

NEW YORK (Reuters Health) Dec 30 - For patients with early, aggressive rheumatoid arthritis (RA), treatment with a combination of adalimumab (Humira, Abbott) and methotrexate leads to a better clinical response than treatment with either agent alone, according to results of the PREMIER study.
Dr. Ferdinand C. Breedveld, from Leiden University Medical Center in the Netherlands, and his colleagues enrolled 799 patients from centers in Australia, Europe and North America. The subjects all had active disease for more than 3 years and had never been treated with methotrexate.
The patients were randomly assigned to subcutaneous injections of adalimumab plus oral methotrexate (n = 268), adalimumab plus placebo (n = 274) or methotrexate plus placebo (n = 257). Adalimumab was initiated at 40 mg every other week, which could be increased to 40 mg every week. Methotrexate was started at 7.5 mg/week, which could be titrated up to 20 mg/week.
One primary co-endpoint was an American College of Rheumatology 50% improvement (ACR50) response. The other co-primary endpoint was radiographic progression according to changes in total Sharp scores. Dr. Breedveld's team reports the findings in the January issue of Arthritis and Rheumatism.
At the end of 1 year, 62% of those in the combination group achieved an ACR50 response, compared with 41% of those in the adalimumab group and 46% of patients in the methotrexate group (p < 0.001 for monotherapy versus combination therapy). This pattern was sustained at 2 years.
At 1 year, the mean increase in Sharp units was 1.3 in the combination group, 3.0 units in the adalimumab group and 5.7 units in the methotrexate group. At 2 years, scores were 1.9, 5.5, and 10.4 Sharp units, respectively.
At the end of 2 years, clinical remission, defined as 28-joint Disease Activity Score < 2.6, was achieved by 43% in the combination group, 23% in the adalimumab group, and 21% in the methotrexate group.
There were no significant differences among groups in the incidence of serious adverse events or in the number of subjects who withdrew because of adverse events. Withdrawal because of a lack of efficacy was less frequent in the combination therapy group (4.9% versus 19.0% and 17.9%).
Thus, the authors conclude," In this population of patients with early, aggressive RA, combination therapy with adalimumab plus methotrexate was significantly superior to either methotrexate alone or adalimumab alone in improving signs and symptoms of disease, inhibiting radiographic progression, and effecting clinical remission."
The PREMIER study was sponsored by Abbott Laboratories.
Arthritis Rheum 2006;54:26-37.