Objective:

To evaluate the effects of inulin supplementation and physiotherapy-supported exercise on pain in patients with knee osteoarthritis.

Key Findings:

• Both inulin and physiotherapy-supported exercise significantly reduced pain compared to placebo.
• No synergistic effect was observed when combining inulin and physiotherapy-supported exercise.
• Physiotherapy-supported exercise improved physical performance metrics, while inulin improved grip strength.
• Inulin was associated with higher pressure pain thresholds and reduced temporal summation.
• Biomarker analyses indicated inulin increased circulating butyrate and GLP-1, with exploratory associations to grip strength.

Interpretation:

The study suggests that both dietary and exercise interventions can effectively reduce pain in knee osteoarthritis, but they do not enhance each other's effects when combined.

Limitations:

• The study was not powered to detect interaction effects.
• Participants could not be blinded to physiotherapy allocation.
• Dropout rates were higher in the physiotherapy-supported exercise group.
• Exploratory findings regarding GLP-1 require independent replication.

Conclusion:

Integrating dietary interventions like inulin with traditional treatments may offer a holistic approach to managing knee osteoarthritis.