Self-education Program for Osteoarthritis Reduces Sodium Intake, Knee Joint pain, and Serum Interleukin-17A level in Osteoarthritis Patients

Objectives: As it has been known that sodium may aggravate joint inflammation throuh IL-17A pathway and it can cause joint pain, the purpose of this study was to determine the effect of the Self Education Programs for Osteoarthritis (SEPO) intervention on sodium intake, knee join pain and IL-17A level in patients with knee osteoarthritis. 
Methods: This multicenter study was conducted in orthopedic and internal medicine outpatient wards in three hospitals. This research has received ethical approval. Patients were recruited based on accidental sampling, who met the inclusion criteria. SEPO intervention was carried out for 30 days, followed by provision of leaflets, posters, and handbook about osteoarthritis, daily WhatsApp education chat and/or video. Patients’ demographic, knee joint pain, and sodium intake data was collected during interview, using the Semi Quantitative Food Frequency Questionnaire (SQ_FFQ), and WOMAC (Western Ontario McMaster Osteoarthritis Index) whereas serum IL-17A was determined by using ELISA. The effect of SEPO was analyzed statistically using Mann Whitney tests (p< 0.05). 
Results: Total subjects recruited were 80, namely 30 patients in control group and 50 patients in treatment group. Majority of patients were female (74, 92.5%), age 56-65 yo (32, 40%), obese (54, 67.5%) and senior high school (23, 46%). Statistical results showed that following SEPO intervention daily sodium intake was lower (1289.45±457.98 mg) compared to the control group (2143.94±744.75 mg), p= 0.04. WOMAC score of control group (28±12.41) higher than treatment group (23.88±13.61), p=0.02. Serum IL-17A levels were also lower in the treatment group (3.974±1.06 pg/mL) than the control group (5.542±1.99 pg/ml), p=0.01. 
Discussion: Education as a non-pharmacological therapy is needed to reduce disease progression. Education is provided according to the patient's needs. Educational models can be offline (face to face) or online (digital). SEPO intervention in patients with knee osteoarthritis can reduce sodium intake, knee joint pain, and may impact on reduction of serum IL-17A. 
 