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Today's blog is written by Dr Xiaoqian Liu from the Institute of Bone and Joint Research. Dr Liu is a rheumatologist from China and is a current PhD student working with Professor David Hunter. Dr Liu's research centres around supplements and OA.


What do you need to know about supplements?
Dietary supplements are defined as a product taken orally intended to supplement the diet and this includes: vitamins, minerals, and herbs. They can come in a variety of forms such as tablets or capsules, liquids, or powders. Given the favorable safety profile in recent times, nutritional supplements for osteoarthritis (OA) are currently riding the crest of public enthusiasm with up to 69% of patients with OA taking some form of supplements for their disease!

However, before you buy any supplements for OA, you need to know that not all supplements are created equally. They are often marketed under different names/brands, with different strengths and levels of purity. Unfortunately at this time, there are no rigorous manufacturing and regulatory processes to ensure how well the supplement work, how consistent the products are, and what these products are made of.


What are the potential benefits of supplements?
1. Ease pain and improve function or disability

Supplements may help with osteoarthritis pain through curbing inflammation around the joint and give you better joint movement.

2. Protect cartilage

Some of supplements are part of what makes up the cartilage in the body such as glucosamine and chondroitin. While they are believed to be nutritional “ingredients” for the bodies cartilage that can protect it from damage, the research in the area is mixed.

3. Safer than anti-inflammatory drugs

Generally supplements are quite safe to use as they are derived from natural products. They are unlikely to cause potential stomach and kidney related side effects which are common if you take anti-inflammatory drugs. So, you can take supplements for a longer time without worrying about side effects.

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Today's blog is written by Dr Leticia Deveza from the Institute of Bone and Joint Research. Dr Deveza is a rheumatologist hailing from Brazil and is a current PhD student working with Professor David Hunter. Leticia has a keen interest in the different phenotypes of osteoarthritis and enjoys running in her free time.


Learning point: This post uses the term “acute” a few times. In this context “acute” refers to a sudden onset.

Changes in weather are frequently reported to trigger increases in pain by people with osteoarthritis and other chronic pain conditions. Around two-thirds of people with knee, hip or hand osteoarthritis reported that the weather affects their pain and, for most people, increases in pain could actually be perceived even before the weather changed!


There are a few theories about the mechanisms behind this phenomenon, including that changes in air pressure associated with weather changes are actually responsible for causing pain flare ups. However, at present, that is no conclusive evidence from studies to support the relationship between weather changes and acute increases in pain in people with knee osteoarthritis.

A recent study was conducted in Australia, intending to shed light on this intriguing, commonly reported association. It included people with knee osteoarthritis and investigated whether temperature, relative humidity, air pressure and precipitation were associated with an increase of at least 20% from the mildest pain reported at the beginning of the study. After 3 months of follow-up, the study found no association between weather and knee pain increases in the 171 participants who experienced at least 1 flare throughout the study.
However, it is important to note that more extreme temperatures (e.g. < 10oC) were uncommon during the study and hence these findings cannot be transferred to other regions that may experience more dramatic weather. Nevertheless, results of this study suggested that there is no relationship between weather and knee pain caused by osteoarthritis and, therefore, it is possible that other factors may play a role in these acute increases in knee pain.

Link to the study:

Ferreira ML, Zhang Y, Metcalf B, Makovey J, Bennell KL, March L, Hunter DJ. The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis - a case-crossover study. Osteoarthritis Cartilage. 2016 Aug 1. pii: S1063-4584(16)30205-9.doi: 10.1016/j.joca.2016.07.016.


Weight loss is very commonly spoken about when it comes to OA. Today we have a post exploring some studies about how weight loss is related to knee OA.

Today's post is written by Dr Sarah Meneses, a researcher and physiotherapist based at the Institute of Bone and Joint Research. Dr Meneses completed her PhD on laser therapy and stretching exercises at the University of Sao Paulo and takes a strong interest in conservative management of osteoarthritis.


It is well known that being overweight or obese can lead to health issues over the time. The joints that carry this extra load suffer and it is common to see a high prevalence of osteoarthritis (OA) within overweight and obese people.


A recent study showed that losing either 5 kg or 5% of body weight has preventive effects on both the structural and clinical signs of knee OA in middle-aged, overweight and obese women without OA.

The authors stated that is necessary to design strategies that are implementable in primary care and effective in reducing body weight of overweight and obese subjects at high-risk of developing knee OA. However, it is important to note that this was an observational study (where researcher are unable to control as much), and we cannot assume a causal relationship (where one variable results in a particular outcome), as there may have been other factors that influenced the results.

Another recent study showed the effect of bariatric surgery (to reduce the size of the stomach) prior to total knee replacement as a cost-effective option for improving outcomes in morbidly obese patients with end-stage knee osteoarthritis.

The authors advised that ideally, a team approach should be used to treat severely obese patients with knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits. The outcomes of this study may assist physicians when counseling patients and developing an individualized treatment plan that includes optimization of overall health, nutrition and weight prior to knee replacement.

These two studies had different subtypes of overweight or obese participants. In the first were included people without OA and in the other were included people in the end-stage of the disease. However, both studies showed a positive effect of weight reduction in the prevention or management of OA. So, keep track of your weight! Speak with your GP and find a real weight loss target for yourself. A weight reduction of 5% already promotes benefits to your health!

Runhaar J, de Vos BC, van Middelkoop M, Vroegindeweij D, Oei EH, Bierma-Zeinstra SM. Moderate weight loss prevents incident knee osteoarthritis in overweight and obese female. Arthritis Care Res (Hoboken). 2016 Feb 11. doi: 10.1002/acr.22854. [Epub ahead of print]

McLawhorn AS, Southren D, Wang YC, Marx RG, Dodwell ER. Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation. J Bone Joint Surg Am. 2016 Jan 20;98(2):e6. doi: 10.2106/JBJS.N.00416.


Welcome to the very first post of 2016! We have writing for us today, Mrs Jillian Eyles, a researcher and physiotherapist at the Institute of Bone and Joint Research. Jill has had many years of experience in clinical physiotherapy at the Royal North Shore Hospital and has recently taken a strong interest in research about knee and hip osteoarthritis.


We all know we should exercise for our general health, what you may not know is why exercise is so important in the management of knee osteoarthritis and which type of exercise is best.


How will exercise help my knee osteoarthritis?
People are often concerned that exercise will cause further damage to their osteoarthritic knee. Rest assured this is a myth! In fact, clinical research has proven that exercise is an effective treatment for knee osteoarthritis and the benefits include:

- Reduction in knee pain
- Improved ability to move around normally
- Improved quality of life
- Reduction in the knee feeling like it is ‘giving way'
- Improved mood
- May assist in weight loss (if required)
- May even help slow down the disease process

So, what is the right type of exercise for my knee osteoarthritis?

Strength training:
Muscles around the knee and hip stabilize the knee and help maintain normal postural alignment during walking and other activities. Muscle weakness is common in knee osteoarthritis. Some muscles become so disused they fail to fire altogether. Strengthening exercises help to build up weak muscles around the hip and knee to protect the knee from forces that load and stress the cartilage.

Strengthening exercises need not require a gym or fancy equipment; some exercises can be performed using your bodyweight alone. You may even prefer to complete your strengthening program in the pool (hydrotherapy or aquatic physiotherapy). The effects of an intensive strengthening program may be felt for up to 6 months, but an ongoing strength maintenance program is recommended for lasting effects.

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Neuromuscular control:
Neuromuscular control is a form strengthening exercise based around everyday movement. People with knee osteoarthritis often adapt their movement patterns to compensate for their knee symptoms. These abnormal movement patterns can cause further weakening of key muscles leading to pain and disability. Exercises that improve the control of the knee during movement also strengthen the muscles around the knee joint and thus help to reduce symptoms of knee osteoarthritis. These exercises are particularly important for those people with osteoarthritis behind the knee-cap.


Flexibility training:
Often osteoarthritic knees feel stiff. However the loss of movement in the knee is not caused by the joint alone but also often involves the muscles. Stretching exercises aim to improve the flexibility of the body by stretching out tight muscles, joints and other tissues. This may lead to improvements in pain. Stretching can be incorporated into any exercise program, or you may want to take a class that focusses on flexibility such as yoga.

fittnes 2.jpg

Fitness training:
We all know that aerobic exercise is good for our heart health; research shows that it is also good for our knees and mental well-being! Aerobic exercise may also help us to shift unwanted kilos that make the pain from knee osteoarthritis a whole lot worse. Low impact activities such as walking, swimming, cycling, aerobic exercise classes and aquafitness are good choices. Aim to include at least 30 minutes of physical activity (at the level of a brisk walk) every day.

There seem to be so many types of exercise I can do- which is the best choice?
Current research suggests that a combination of strength, fitness and flexibility training is the most effective way to reduced pain and improve your ability to move around (and do the things you enjoy!). You may want to mix up the type of training that you do so that it doesn’t become a chore. The best choices of exercise type are the ones that you enjoy, and if you exercise with a friend or two it may double up as a social activity- anyone for coffee after?

How do I start exercising for my knee osteoarthritis?
It is important to seek advice from a health professional before you start an exercise program. Ask your physiotherapist or GP to help get you started with an exercise program that is right for you!


The researchers here at the Institute of Bone and Joint Research (IBJR) are pleased to bring you summaries of the latest research in the musculoskeletal research arena. We will summarise recently published research from around the world and within the IBJR. We’re starting the series off with an in-house research study about an online OA management resource from Australia.

Today we will be talking about an original research paper titled “The Web-based Osteoarthritis Resource My Joint Pain Improves Quality of Care: A Quasi Experimental Study” which was published earlier this year in the Journal of Medical Internet Research.


Osteoarthritis (OA) is the leading cause of chronic pain and is estimated to affect 1 in 8 adults. Due to the aging population and the increasing rates of obesity in developed countries, it is expected that the incidence of OA will double by the year 2020! Current clinical practice for OA management is often centred on pain relief and eventually surgery despite numerous evidence based guidelines advocating conservative treatment options. The lack of efficiency in practice highlights the need for patients to receive evidence based information about OA outside the clinical encounter. While this is already regularly done in self-management programs to allow patients to play an active role in improving their condition, the use of online platform to distribute the information will have a much wider reach. Hence, the My Joint Pain website was developed.

The research was carried out over 12 months with participants from all over Australia in what is called a quasi-experimental study. This means that instead of being randomised to a group of the study, participants could choose for themselves. Participants filled out an online survey to assess eligibility and if eligible, the questionnaires used in this study. Once the My Joint Pain website was available, participants were informed and were only contacted again after 12 months to fill out the same questionnaires and to provide details of their website usage (to divide them into users and non-users).

The two questionnaires used for this study were the Health Evaluation Impact Questionnaire (heiQ) and the Osteoarthritis Quality Indicator (OAQI).

The heiQ was designed to evaluate the effects of self-management programs in 8 different categories that include health directed activity, emotional distress and health service navigation. This study found that over 12 months, users of the website had greatly improved in most categories where non-users didn’t change. Most interestingly, the only change in the non-users was emotional distress. It appears that by using the website, participants were able to protect their emotional wellbeing by preventing it from deteriorating as is usually seen in people with worsening OA and in our non-users.

The OAQI assessed the appropriateness of care received by patients and evaluates 17 different aspects including disease development, weight reduction, and surgery. Comparing user and non- users showed significant differences in self-management and weight reduction. Many of the significant changes seen (even just within the group) were centred on the more conservative options which suggested that the website was effective in dispersing information about conservative options

To read the full paper and more about the results use this link:

My Joint Pain is free and available at this link

You can also support the research carried out the Institute of Bone and Joint Research here:
All donations above $2 are tax deductible.

Umapathy H, Bennell K, Dickson C, Dobson F, Fransen M, Jones G, Hunter DJ
The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study
J Med Internet Res 2015;17(7):e167
DOI: 10.2196/jmir.4376
PMID: 26154022
PMCID: 4526979


We have a special message all the way from Scandinavia from Professor Ewa Roos!

Here from the IBJR we wish everyone a very Happy Holiday season!

At this time of the year, as you all well know, it is time for Santa to fill up his sack with presents for everyone, including those middle‐aged and elderly suffering from pain due to knee and hip osteoarthritis. And wow, there seem to be more and more of them every year! And they complain. They complain they can no longer dance around the Christmas tree. Neither can they sit for as long as the Christmas dinner lasts, without feeling stiffness. Santa thought about his own painful knees for a while, sighed, and then contemplated what treatments to put in his sack.....

Click Here to download the rest of the message



It has been a little quiet on this blog! To tide you over while we work on some new material, here is a interview on ABC with the Institute of Bone and Joint Research's chairman, Professor David Hunter.

Click here to hear Professor Hunter and Damian Smith chat about the cost of Osteoarthritis!!


Many fitness enthusiasts would say that fitness is their drug. They are actually not that far off from the truth. Exercise has been found to provide benefits to many different medical conditions such as heart disease and high blood pressure. In osteoarthritis, exercise provides moderate benefits to pain levels. While this may not seem like much, it is actually about the same relief you can get from simple pain relief medications like Paracetamol (Panadol) and oral anti-inflammatories (NSAIDS) like Ibuprofen which are the first line drug treatments for many sufferers of OA.

With this knowledge it’s clear that exercise will be good for you but what kind is best when your joints are already vulnerable? There are many types of exercises that are prescribed including cardiovascular exercising (like cycling or walking), balance training and muscle strengthening. These exercises work by strengthening the muscles that control and stabilise your knee, reducing joint load by weight loss and by improving your general health!

There are many recommended exercises but here are a few tips to get started:

• Try low impact activities to reduce the force going through your joints. This includes things like walking, swimming (the heated pool will feel great!) or Tai Chi.
• Aim to exercise for about 30 minutes a day. This could even be in blocks of 10 minutes.
• Plan your exercise for when you experience the least pain or stiffness in the day or even when your medications are most effective.

Muscle strengthening is also really important for lower limb OA and here are a few simple exercises you can try:

1)Standing Calf Raises


Starting position
Stand on two feet near a wall or table. Hold on gently to maintain balance.

Keeping the knee straight, rise up on the toes and hold for 3 to 5 seconds then lower slowly.
Try to do 2 to 3 sets of 10 repetitions

Hint: The exercise can be made more difficult by doing it on one leg

2)Partial wall squats

wall sit.jpg

Starting position
Stand with feet approximately one foot (30cm) away from the wall and feet apart. Slightly turn your feet outwards (if you get pain in the front of your knees with this exercise related to kneecap arthritis we would not encourage this exercise).

Lean your trunk and buttocks against a wall and keep your back straight.

Slowly slide down the wall (as if to sit) keeping your body in contact with the wall as you do.
Keep your knees moving over your toes.
Stop when your knees are bent to about 60 degrees (or less if it is painful).
Hold the position for 5 seconds.
Slowly slide back up keeping your body in contact with the wall as you do.

Try doing 2 to 3 sets of 10 repetitions

A physiotherapist can help recommend more exercise suited to your needs and ability.

For more information on physical activity and OA check out the physical activity fact sheet on


Christmas time is probably one of the most difficult times to watch your weight. With everyone giving you chocolates, mince pies and many treats along with the Christmas Eve/Christmas day/post-Christmas feasting, it’s quite likely to have put on a little bit of weight by the start of the New Year.

But when you have osteoarthritis and are overweight, putting on more weight is probably not a great thing. A lot of emphasis is put on weight loss by doctors in regards to reducing OA pain the knee, hip and back. There are actually a few good reasons for that! Firstly, obesity (Body Mass Index > 30) increases the risk of OA in women by four folds and men by almost 5 times [1]. A weight loss of just 5kg reduces the risk of developing OA by half[2]. Secondly, research has found that a 10% body weight reduction results in up to a 50% reduction in pain. In fact, the same study showed that 38% of participants reported little or no pain after their weight loss![3]

The big question really is about how weight affects OA. While not everyone who has osteoarthritis is overweight and vice versa, obesity is considered a great risk factor to develop OA. Excess weight can affect the joint in a number of ways including an increase in the amount of force on you joints. The knee, hip and back are called load bearing joints because, well, they bear load. The extra body weight creates an abnormal load for this joint causing them to essentially wear out faster. Furthermore, cartilage (which is found in the joint) responds to the increased loads by triggering mechanisms that result in the production of harmful material that can lead to the destruction of the joint[4].


Another thing that researchers have noticed is that obesity is still a risk for OA in joints that do not hold up any weight like your thumb. This is because the fat cells release molecules that result in inflammation in your whole body which can affect the health of the joints. These molecules have been found to increase the loss of cartilage and affect the severity of arthritis[5].

There are many more details to how obesity affects osteoarthritis but the bottom line is that obesity is bad news for joints. The good news is you can still make positive changes and losing weight can make an enormous difference not only to the health of your joints but also your general health.

If you would like some tips on weight loss check out this amazing fact sheet about weight loss and how you might achieve this on

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