Exercise, supplements may curb osteoarthritis. (Drugs Also Show Promise).

PHILADELPHIA -- Numerous interventions are showing promise for altering the course of osteoarthritis, Dr. Sharon Kolasinski reported at a rheumatology update sponsored by the University of Pennsylvania.

Exercise and weight loss have repeatedly been shown to be helpful in patients with this disease, and the findings of recent trials confirm their benefits. Findings from the Observational Arthritis Study in Seniors (OASIS) trial published last year, for example, showed that improving knee strength may reduce knee pain and disability, said Dr. Kolasinski, chief of clinical services in the division of rheumatology at the university.

In two other studies, supervised exercise and weight loss programs resulted in significant reduction in pain and disability scores. Western Ontario and McMaster Universities (WOMAC) pain scores improved by 55% in one study and by 44% in another, while WOMAC disability scores decreased by more than 20%, she said at the meeting, which was also sponsored by the Department of Veterans Affairs.

In addition to these straightforward measures for intervening in osteoarthritis, Dr. Kolasinski discussed several interventions that target cartilage or bone and might also be of benefit:

* Vitamin C. Framingham data revealed that this antioxidant doesn't protect against OA, but it does appear to slow progression. In a comparison of 453 normal volunteers and 187 OA patients, high intake was associated with a threefold decrease in progression of disease.

* Glucosamine/Chondroitin. Metaanalyses suggest that the use of these supplements provides short-term analgesic benefit in OA patients with an effect comparable to that seen with NSAIDs. But the effect, which occurs in about 60% of patients, is delayed. Glucosamine and chondroitin tend to provide benefit in about 2 weeks, while NSAIDS provide benefit in 17 days.

In larger, high-quality studies, the benefit appears to be somewhat smaller than in less well-designed studies. Studies in animals are showing that glucosamine is bioavailable to chondrocytes in joint cartilage, and that it may indeed be disease modifying, Dr. Kolasinski said.