Knee OA care: Focusing on lifestyle



Although osteoarthritis (OA) presents a considerable burden, affecting individuals' quality of life, there are several straightforward actions that can help prevent or slow its progression.

Although osteoarthritis (OA) presents a considerable burden, affecting individuals’ quality of life, there are several straightforward actions that can help prevent or slow its progression.

Recent studies presented at EULAR congress in 2023 reveal groundbreaking insights into managing OA through lifestyle changes such as adopting a healthy lifestyle, especially by quitting smoking, avoiding sedentary behaviour, or following dietary modifications and stress management programs.

Osteoarthritis is a chronic degenerative joint disorder characterized by the gradual breakdown of cartilage within the affected joints, often accompanied by an important inflammatory response. It is known that smoking induces inflammation suggesting potential negative effects on the development and progression of OA.

Recent research by Salis et al., 20231 has shed light on the detrimental role of smoking in knee osteoarthritis (KOA). By comparing never smokers, former smokers, and current smokers they found that current smokers presented higher baseline scores for pain, disability, and stiffness compared to their non-smoking counterparts. Conversely, former smokers displayed baseline scores comparable to those of never smokers. Moreover, within the group of current smokers, the odds of developing radiographic KOA (i.e. grade 2 or greater severity (0-3 scale) or the presence of moderate to severe joint space narrowing) was 27% higher than in the other two groups over a follow-up period of 4 to 5 years. Therefore, quitting smoking emerges as a crucial step in preventing or mitigating KOA symptoms and structural defects.

Lifestyle represents another modifiable risk factor in the prevention of OA, regardless the genetic background. Chen et al., 20232 explored the association of lifestyle and OA risk using a cohort of 317884 participants from the UK biobank.

The authors defined a “healthy status” based on a body mass index (BMI) lower than 30Kg/m2, a minimum of 270 minutes of physical activity per week, less than 4 hours per day of sedentary time and a daily sleep duration of 7-8h. These parameters were assessed as part of a lifestyle score ranging from 0-1 (unfavourable), 2-3 (intermediate) and 4-5 (favourable). Additionally, the study evaluated genetic susceptibility through a polygenic risk score (PRS), based on the presence of risk alleles, categorized as 0, 1, or 2. Finally, the diagnosis of total, knee, or hip OA was established according to the International Classification of Diseases (ICD) codes ICD-9 and ICD-10.

The findings revealed a significant association between a favourable lifestyle and a decreased risk of total OA regardless of whether individuals were in the low, intermediate, or high genetic risk profiles (HR, 0.64; 95%CI, 0.58-0.70; HR, 0.59; 95%CI, 0.56-0.63 and HR, 0.58; 95%CI, 0.53-0.64, respectively). Similar outcomes were obtained for knee and hip OA across the three PRS groups. However, no significant interaction was observed between lifestyle and PRS, suggesting that healthier lifestyles may attenuate the risk of developing osteoarthritis regardless the genetic predisposition.

In line with the previous study, a more holistic program intervention including whole-food plantbased diet, physical activity and stress management showed benefits in KOA associated to metabolic syndrome management (Wagenaar et al., 2024)3.

Under the name of “Plants For Joints” (PFJ), this 16-week multidisciplinary lifestyle intervention engaged participants in educational sessions focused on plant-based nutrition, setting personal physical activity goals, and receiving coaching on stress management, alongside their usual care. PFJ program significantly improved pain and joint function assessed by The Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC), and slightly reduced pain medication. Furthermore, remarkable reductions in weight and HbA1c levels (indicative of average blood glucose levels over the preceding two to three months) were evident, suggesting an enhanced management of metabolic syndrome. 73% of participants who completed the one-year follow-up exhibited slightly greater average improvements in WOMAC scores, body weight, and inflammatory markers such as CRP protein, compared to noncompleters. Importantly, the positive effects of the PFJ lifestyle intervention on pain and function persisted up to one year after program completion. While the metabolic benefits were partially sustained, there were indications of reduced adherence to the lifestyle program during the one-year follow-up period.

In conclusion, addressing modifiable risk factors such as quitting smoking, adopting a healthy lifestyle, and embracing holistic interventions like the PFJ program are pivotal in managing KOA. By implementing these strategies, individuals can potentially alleviate symptoms, slow disease progression, and enhance overall well-being. Encouraging lifestyle modifications and providing comprehensive interventions are imperative steps in the multifaceted approach to combating KOA.

  1. Salis Z, Sainsbury-Salis A. Compared to People Who Never Smoked, Current Smokers but Not Former Smokers Have Worse Knee Osteoarthritis Symptoms and Structural Defects: Individual Participant Data Meta-Analyses of Multi-Cohort Data. Annals of the Rheumatic Diseases. 2023.
  2. Chen S, Zhang Y, Fan T, Zeng M, LI J, Ruan G, et al. Association of healthy lifestyle, genetic susceptibility and incidence of osteoarthritis: a national prospective cohort study. Annals of the Rheumatic Diseases. 2023.
  3. Wagenaar CA, Walrabenstein W, van der Leeden M, et al. Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis and osteoarthritis: 1-year follow-up of the ‘Plants for Joints’ randomised clinical trial. RMD Open. 2024 Feb 27;10(1): e004025

Link to full studies

This article is a summary based on the following study. For more information and details, please consult the full study. Please do not hesitate to contact us if you have any comments.


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