Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
National Health and Nutrition Survey III (1988-94,USA) data showed a low K+ body status in RA. Further information is scanty. K+ is critical to ‘pain’ [nociceptive processing, K+ ion channel downregulation (Tsantoulas. Trends Neurosci 2014; 37:146) and related process e.g. oxidant tissue damage and T lymphocytes function [K2P5.1 (Bitner. Arthritis Res Therapy 2011;13:R 21), Kv1.3 & KCa3.1 channels (Lam. Drug Dev Res 2011; 72: 573] and cortisol secretion. Using Indian standards (National Institute of Nutrition, Hyderabad) and controlled diet survey, we showed that K+ was low (p<0.5) in RA patients, more so in women (EULAR 2014).
Methods: 172 consenting chronic RA patients (ACR 1987 classified, mean age 49.9 years, 89 % women, mean duration 9.9 years,74% seropositive RF) with active pain(visual analogue scale > 4 cm) were randomized into an assessor blind, three arm study of 16 week duration in a community rheumatology center. Standardized oral K+ intake was based on K+ rich vegetarian balanced diet in Arm A (3.5-4 gm K+ daily) and an additional K+ supplement powder (K+ rich pulses & seeds plus oral rehydration salt(3 gm K+), Indian pharmacopeia) in Arm B (7.5-8 gm K+ daily); local diet preferences considered. Arm C was control (routine diet , 2-3 gm K+ daily). Patients continued pre-study suprvised standard rheumatology care/drugs (72% methotrexate, mean weekly dose 14 mg;60% prednisolone, mean4 mg daily); analgesic rescue permitted and monitored as per protocol. No other non-drug intervention advised. Standard efficacy/safety measures and diet intake were evaluated every month. Compliance check included urinary K+ assay. The study (80% power, significant p <0.05) was analyzed using SPSS; NS: p, not significant. Arms were well matched for several measures (for mean DAS 28: A=4.9; B=5.5; C=4.9) and withdrawals (A: 8.8%; B:12.1%; C: 8.8%).
Pain and several ACR efficacy measures improved (P<0.05) by intervention; difference was NS by intent to treat analysis/ITT (mean change pain VAS: A=-1.3 cm; B=2 cm; C= 1.2; p=0.17, ANOVA).But completer analysis showed significant change (p=0.04) in mean pain VAS in the B intervention arm (high K+ intake). B arm also showed best response (ITT, P<0.05) in proportion patients with at least 50% reduction and minimal clinical important difference in pain VAS on completion from baseline. Maximum improvement (NS) in HAQ (Indian validated version) and SF 36 physical score was seen in the B arm. There was reduction (NS) in the mean DAS 28 score by intervention (A:-1.4; B:-1.2; C: -0.9). Only mild AE were reported (<8% patients by study arm). On completion, B arm demonstrated a maximum serum cortisol (AM) increase. K+ intervention arms showed reduction in systolic BP. Ongoing medication, dietary factors and compliance, disease activity status may confound results.
This pragmatic interventional control study in patients suffering from chronic symptomatic RA showed a clinically important pain reduction over and above standard drug treatment using dietary K+ augmentation. Other possible benefits were reduced disease activity and improved BP (cardiovascular) status. Overall, this seemed to be a gentle useful and safe adjunct therapy.
To cite this abstract in AMA style:Kainifard T, Saluja M, Venugopalan A, Rane R, Chopra A. Oral Potassium (K+) Reduces Pain in RA: A Randomized Active Control Study of Diet Based K+ Intervention [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/oral-potassium-k-reduces-pain-in-ra-a-randomized-active-control-study-of-diet-based-k-intervention/. Accessed May 20, 2018.
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