The Intensive Diet and Exercise for Arthritis (IDEA) Trial: 18-Month Radiographic and MRI Outcomes

SummaryPurposeReport 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).MethodsProspective, 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.ResultsMean 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).ConclusionDespite 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

p53 expression in dyskeratosis congenita: a marker for oral premalignancy?

As p53 expression has been associated with malignant disease its presence was assessed in biopsy specimens from dorsal lingual hyperkeratosis, taken over a five year period. p53 expression, using CM1, was assessed using a standard immunoperoxidase technique. p53 was not identified in the first biopsy specimen in 1986 but was identified in all subsequent ones. Only in the latest biopsy specimen was there evidence for dysplasia in haematoxylin and eosin stained sections. It is suggested that p53 expression may be a reliable marker for predicting premalignant change in keratoses occurring in dyskeratosis congenita