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      Obesity & osteoarthritis

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          Abstract

          The most significant impact of obesity on the musculoskeletal system is associated with osteoarthritis (OA), a disabling degenerative joint disorder characterized by pain, decreased mobility and negative impact on quality of life. OA pathogenesis relates to both excessive joint loading and altered biomechanical patterns together with hormonal and cytokine dysregulation. Obesity is associated with the incidence and progression of OA of both weight-bearing and non weight-bearing joints, to rate of joint replacements as well as operative complications. Weight loss in OA can impart clinically significant improvements in pain and delay progression of joint structural damage. Further work is required to determine the relative contributions of mechanical and metabolic factors in the pathogenesis of OA.

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          Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis.

          Robin Christensen, Arne Astrup, Henning Bliddal … (2007)
          This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of >0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of >5% should be achieved within a 20-week period--that is, 0.25% per week.
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            The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis.

            Annegret Mündermann, Thomas P Andriacchi (2006)
            This review examines recent in-vivo studies of ambulation and discusses the fundamental role of mechanics of ambulation in the initiation and progression of osteoarthritis at the knee. Recent studies have supported earlier findings that a high adduction moment at the knee during ambulation was most frequently reported to influence the progression of medial compartment osteoarthritis. In contrast to previous findings in patients with osteoarthritis, recent work on healthy subjects reports that cartilage thickness increases with high ambulatory loads. Kinematic changes were associated with the initiation of osteoarthritis. Recent studies of subjects with high risk factors for knee osteoarthritis (obesity and anterior cruciate ligament injury) reported a relationship between kinematic changes during ambulation and the initiation of osteoarthritis at the knee. This review also contrasts the relative influence on osteoarthritis of knee mechanics measured during ambulatory and nonambulatory activities. The initiation of osteoarthritis occurs when healthy cartilage experiences some condition (traumatic or chronic) that causes kinematic changes during ambulation at the knee to shift the load-bearing contact location of the joint to a region not conditioned to the new loading. The rate of progression of osteoarthritis is associated with increased load during ambulation.
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              Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study.

              Johanna M. W. Hazes, Janneke N. Belo, A Bergink … (2007)
              To investigate the relationship between body mass index (BMI) and the incidence and progression of radiological knee as well as of radiological hip osteoarthritis. Cohort study. Population based. 3585 people aged > or =55 years were selected from the Rotterdam Study, on the basis of the availability of radiographs of baseline and follow-up. Incidence of knee or hip osteoarthritis was defined as minimally grade 2 at follow-up and grade 0 or 1 at baseline. The progression of osteoarthritis was defined as a decrease in joint space width. x Rays of the knee and hip at baseline and follow-up (mean follow-up of 6.6 years) were evaluated. BMI was measured at baseline. A high BMI (>27 kg/m(2)) at baseline was associated with incident knee osteoarthritis (odds ratio (OR) 3.3), but not with incident hip osteoarthritis. A high BMI was also associated with progression of knee osteoarthritis (OR 3.2). For the hip, a significant association between progression of osteoarthritis and BMI was not found. On the basis of these results, we conclude that BMI is associated with the incidence and progression of knee osteoarthritis. Furthermore, it seems that BMI is not associated with the incidence and progression of hip osteoarthritis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Med Res
                Journal ID (iso-abbrev): Indian J. Med. Res
                Journal ID (publisher-id): IJMR
                Title: The Indian Journal of Medical Research
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0971-5916
                ISSN (Electronic): 0975-9174
                Publication date (Print): August 2013
                Volume: 138
                Issue: 2
                Pages: 185-193
                Affiliations
                [* ] Sydney Medical School, The University of Sydney, Sydney, Australia
                [** ] Institute of Bone & Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
                [+ ] Department of Rheumatology, Concord Hospital, Sydney, Australia; The University of Sydney, Australia
                Author notes
                Reprint requests: Dr Ananthila Anandacoomarasamy, Department of Rheumatology, Concord Hospital, Hospital Rd, Concord West, NSW 2138, Australia e-mail: anaananda@ 123456med.usyd.edu.au
                Article
                Publisher ID: IJMR-138-185
                PMC ID: 3788203
                PubMed ID: 24056594
                SO-VID: 6e51dc76-456e-43a4-868c-2e3a2277de40
                Copyright © Copyright: © The Indian Journal of Medical Research
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 March 2013
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Medicine
                Keywords: adipokine,body mass index,cartilage,obesity,osteoarthritis,weight loss
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: adipokine, body mass index, cartilage, obesity, osteoarthritis, weight loss

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