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Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Review Article

How to Treat Osteoarthritis in Obese Patients?

Author(s): Thierry Conrozier*

Volume 16, Issue 2, 2020

Page: [99 - 104] Pages: 6

DOI: 10.2174/1573397115666190625105759

Price: $65

Abstract

The close association between osteoarthritis (OA) and obesity is well established. Mechanisms linking obesity and OA involve multifactorial phenomena such as systemic factors (i.e. adipokines and pro-inflammatory cytokines), hormonal disturbances (hyperinsulinemia) and muscule changes (i.e. sarcopenia and lower muscular tone). The concomitant increasing prevalence of the two diseases have major health, social and economic consequences. However, to date no specific recommendation for the medical management of obese patients with OA have been published. Current recommendations only specify that obese patients must lose weight and practice regular physical activity in addition to the usual care. Weight loss improves not only OA symptoms but also metabolic abnormalities and cardiovascular risk factors commonly altered in subjects with obesity. OA symptoms’ improvement has been shown to become clinically relevant from a weight loss > 5% of the body weight. In case of morbid obesity, bariatric surgery may be the only alternative for pain relief. After bariatric surgery, an appropriate calcium and vitamin D intake is recommended, since it has been shown that bariatric surgery was associated with a reduction in the bone mineral density and increased risk of fractures. An exercise program is essential for preserving healthy muscles during weight loss.

Non-steroidal anti-inflammatory drugs and corticosteroids must be avoided, especially in obese patients with metabolic syndrome. In such patients symptomatic slow acting drugs for OA (i.e. glucosamine, chondroitin) and some anti-oxidant drugs (i.e. curcumin, ginger extracts, copper) may be helpful thanks to their excellent benefit/risk ratio and their mode of action which may have a positive impact on both OA and obesity-related metabolic disorders. Recent research focuses on the development of molecules aimed for promoting the production of heme oxygenase (HO-1). HO-1 decreases the production of oxygen free radicals and protects tissues from oxidative stress in the insulin resistance syndrome. Intra-articular (IA) injections of hyaluronic acid and corticosteroid have few adverse events. However, physicians must inform patients that IA treatments have a lower success rate in obese patients than in those with normal body mass index. Spa therapy contributes to relief pain, favour weight-loss and reduces metabolic abnormalities with a favourable risk/benefit balance.

Keywords: Obesity, body mass index, osteoarthritis, metabolic syndrome; spa, anti-oxidant, SYSADOA, knee, bariatric surgery, weight-loss.

Graphical Abstract
[1]
Lementowski PW, Zelicof SB. Obesity and osteoarthritis. Am J Orthop 2008; 37(3): 148-51.
[PMID: 18438470]
[2]
Wendelboe AM, Hegmann KT, Biggs JJ, et al. Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med 2003; 25(4): 290-5.
[http://dx.doi.org/10.1016/S0749-3797(03)00218-6] [PMID: 14580629]
[3]
Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev 2014; 15(7): 578-86.
[http://dx.doi.org/10.1111/obr.12173] [PMID: 24751192]
[4]
Fautrel B, Hilliquin P, Rozenberg S, et al. Impact of osteoarthritis: results of a nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine 2005; 72(3): 235-40.
[http://dx.doi.org/10.1016/j.jbspin.2004.08.009] [PMID: 15850995]
[6]
Wills AK, Black S, Cooper R, et al. Life course body mass index and risk of knee osteoarthritis at the age of 53 years: evidence from the 1946 British birth cohort study. Ann Rheum Dis 2012; 71(5): 655-60.
[http://dx.doi.org/10.1136/ard.2011.154021] [PMID: 21979003]
[7]
Yusuf E, Nelissen RG, Ioan-Facsinay A, et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis 2010; 69(4): 761-5.
[http://dx.doi.org/10.1136/ard.2008.106930] [PMID: 19487215]
[8]
Visser AW, de Mutsert R, le Cessie S, den Heijer M, Rosendaal FR, Kloppenburg M. The relative contribution of mechanical stress and systemic processes in different types of osteoarthritis: the NEO study. Ann Rheum Dis 2015; 74(10): 1842-7.
[http://dx.doi.org/10.1136/annrheumdis-2013-205012] [PMID: 24845389]
[9]
Salmon JH, Rat AC, Sellam J, et al. Economic impact of lower-limb osteoarthritis worldwide: a systematic review of cost-of-illness studies. Osteoarthritis Cartilage 2016; 24(9): 1500-8.
[http://dx.doi.org/10.1016/j.joca.2016.03.012] [PMID: 27034093]
[10]
Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62(12): 1145-55.
[http://dx.doi.org/10.1136/ard.2003.011742] [PMID: 14644851]
[11]
Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64(4): 465-74.
[http://dx.doi.org/10.1002/acr.21596] [PMID: 22563589]
[12]
McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22(3): 363-88.
[http://dx.doi.org/10.1016/j.joca.2014.01.003] [PMID: 24462672]
[13]
Bruyère , Cooper C, Pelletier JP. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally:A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014. S0049-0172(14)00108-5.
[http://dx.doi.org/10.1016/j.semarthrit.2014.05.014]
[14]
Courties A, Berenbaum F, Sellam J. Obésité et arthrose: actualités sur une association plus complexe que prévu. Rev Rhum 2015; 82: 170-2.
[http://dx.doi.org/10.1016/j.rhum.2014.11.008]
[15]
Courties A, Sellam J. Obésité et arthrose: données physiopathologiquesRev Rhum monographies 2016.
[16]
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66(4): 433-9.
[http://dx.doi.org/10.1136/ard.2006.065904] [PMID: 17204567]
[17]
Conrozier T, Marre JP, Payen-Champenois C, Vignon E. National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence. Clin Exp Rheumatol 2008; 26(5): 793-8.
[PMID: 19032810]
[18]
Messier SP, Loeser RF, Mitchell MN, et al. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. J Am Geriatr Soc 2000; 48(9): 1062-72.
[http://dx.doi.org/10.1111/j.1532-5415.2000.tb04781.x] [PMID: 10983905]
[19]
Henriksen M, Christensen R, Danneskiold-Samsøe B, Bliddal H. Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. Arthritis Rheum 2012; 64(2): 438-42.
[http://dx.doi.org/10.1002/art.33394] [PMID: 22161649]
[20]
Richette P. Chirurgie bariatrique et rhumatologie Rev Rhum monographies 2016; 83: 56-8.
[21]
Groen VA, van de Graaf VA, Scholtes VA, Sprague S, van Wagensveld BA, Poolman RW. Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review. Obes Rev 2015; 16(2): 161-70.
[http://dx.doi.org/10.1111/obr.12236] [PMID: 25487972]
[22]
Richette P, Poitou C, Garnero P, et al. Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Ann Rheum Dis 2011; 70(1): 139-44.
[http://dx.doi.org/10.1136/ard.2010.134015] [PMID: 20980288]
[23]
Uebelhart B. [Effects of bariatric surgery on bone]. Rev Med Suisse 2013; 9(390): 1251-5.
[PMID: 23821842]
[24]
Gremese E, Bernardi S, Bonazza S, et al. Body weight, gender and response to TNF-α blockers in axial spondyloarthritis. Rheumatology (Oxford) 2014; 53(5): 875-81.
[http://dx.doi.org/10.1093/rheumatology/ket433] [PMID: 24407233]
[25]
Kearsley-Fleet L, Davies R, De Cock D, et al. Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 2018; 77(10): 1405-12.
[http://dx.doi.org/10.1136/annrheumdis-2018-213378] [PMID: 29980575]
[26]
Bruyère O, Cooper C, Pelletier JP, et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis—From evidence-based medicine to the reallife setting. Semin Arthritis Rheum 2016. 45(4): Suppl S3-S11.
[27]
Richette P, Latourte A, Frazier A. Safety and efficacy of paracetamol and NSAIDs in osteoarthritis: which drug to recommend? Expert Opin Drug Saf 2015; 14(8): 1259-68.
[http://dx.doi.org/10.1517/14740338.2015.1056776] [PMID: 26134750]
[28]
Chevalier X, Conrozier T. Access to highly purified chondroitin sulfate for appropriate treatment of osteoarthritis: a review. Med Access @. Point Care 2017; 1(1): e134-44.
[http://dx.doi.org/10.5301/maapoc.0000022]
[29]
Bruyère O, Altman RD, Reginster JY. Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum 2016; 45(4)(Suppl.): S12-7.
[http://dx.doi.org/10.1016/j.semarthrit.2015.11.011] [PMID: 26806187]
[30]
Głuszko P, Stasiek M. Symptom-modifying effects of oral avocado/soybean unsaponifiables in routine treatment of knee osteoarthritis in Poland. An open, prospective observational study of patients adherent to a 6-month treatment. Reumatologia 2016; 54(5): 217-26.
[http://dx.doi.org/10.5114/reum.2016.63661] [PMID: 27994265]
[31]
Son Y, Lee JH, Chung HT, Pae HO. Therapeutic roles of heme oxygenase-1 in metabolic diseases: curcumin and resveratrol analogues as possible inducers of heme oxygenase-1. Oxid Med Cell Longev 2013; 2013 639541
[http://dx.doi.org/10.1155/2013/639541] [PMID: 24101950]
[32]
Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food 2016; 19(8): 717-29.
[http://dx.doi.org/10.1089/jmf.2016.3705] [PMID: 27533649]
[33]
Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol 2016; 35(10): 2531-40.
[http://dx.doi.org/10.1007/s10067-016-3363-1] [PMID: 27470088]
[34]
Dave S, Kaur NJ, Nanduri R, Dkhar HK, Kumar A, Gupta P. Inhibition of adipogenesis and induction of apoptosis and lipolysis by stem bromelain in 3T3-L1 adipocytes. PLoS One 2012; 7(1) e30831
[http://dx.doi.org/10.1371/journal.pone.0030831] [PMID: 22292054]
[35]
Torres-Fuentes C, Theeuwes WF, McMullen MK, et al. Devil’s Claw to suppress appetite--ghrelin receptor modulation potential of a Harpagophytum procumbens root extract. PLoS One 2014; 9(7) e103118
[http://dx.doi.org/10.1371/journal.pone.0103118] [PMID: 25068823]
[36]
Denner SS. A review of the efficacy and safety of devil’s claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis. Holist Nurs Pract 2007; 21(4): 203-7.
[http://dx.doi.org/10.1097/01.HNP.0000280932.65581.72] [PMID: 17627199]
[37]
Conrozier T, Mathieu P, Bonjean M, Marc JF, Renevier JL, Balblanc JC. A complex of three natural anti-inflammatory agents provides relief of osteoarthritis pain. Altern Ther Health Med 2014; 20(Suppl. 1): 32-7.
[PMID: 24473984]
[38]
Poulet B, Staines KA. New developments in osteoarthritis and cartilage biology. Curr Opin Pharmacol 2016; 28: 8-13.
[http://dx.doi.org/10.1016/j.coph.2016.02.009] [PMID: 26921602]
[39]
Rousset F, Grange L, Nguyen MVC, et al. Impact of the Addition of Ginger Extract and Copper Sulphate to Glucosamine Sulphate on Il-1β-Stimulated Chondrocytes Rheum Dis Treat 2016. 2(3):038.
[40]
Chevalier X. Intraarticular treatments for osteoarthritis: new perspectives. Curr Drug Targets 2010; 11(5): 546-60.
[http://dx.doi.org/10.2174/138945010791011866] [PMID: 20199394]
[41]
Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 2015; 162(1): 46-54.
[http://dx.doi.org/10.7326/M14-1231] [PMID: 25560713]
[42]
Waterbrook AL, Balcik BJ, Goshinska AJ. Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review. Sports Health 2017; 9(4): 372-4.
[http://dx.doi.org/10.1177/1941738117702585] [PMID: 28394710]
[43]
Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg 2017; 25(10): 703-14.
[http://dx.doi.org/10.5435/JAAOS-D-16-00541] [PMID: 28953085]
[44]
Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum 2009; 61(12): 1704-11.
[http://dx.doi.org/10.1002/art.24925] [PMID: 19950318]
[45]
Eymard F, Chevalier X, Conrozier T. Obesity and radiological severity are associated with viscosupplementation failure in patients with knee osteoarthritis. J Orthop Res 2017; 35(10): 2269-74.
[http://dx.doi.org/10.1002/jor.23529] [PMID: 28128473]
[46]
Conrozier T, Monet M, Lohse A, Raman R. Getting Better or Getting Well? The Patient Acceptable Symptom State (PASS) Better Predicts Patient’s Satisfaction than the Decrease of Pain, in Knee Osteoarthritis Subjects Treated with Viscosupplementation. Cartilage 2017; 1947603517723072
[http://dx.doi.org/10.1177/1947603517723072] [PMID: 28800711]
[47]
Tubach F, Ravaud P, Baron G, et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 2005; 64(1): 34-7.
[http://dx.doi.org/10.1136/ard.2004.023028] [PMID: 15130902]
[48]
Eymard F, Maillet B, Lellouche H, et al. Predictors of response to viscosupplementation in patients with hip osteoarthritis: results of a prospective, observational, multicentre, open-label, pilot study. BMC Musculoskelet Disord 2017; 18(1): 3.
[http://dx.doi.org/10.1186/s12891-016-1359-2] [PMID: 28056915]
[49]
Bossert M, Boublil D, Parisaux JM, Bozgan AM, Richelme E, Conrozier T. Imaging guidance improves the results of viscosupplementation with HANOX-M-XL in patients with ankle osteoarthritis: Results of a clinical survey in 50 patients treated in daily practice. Clin Med Insights Arthritis Musculoskelet Disord 2016; 9: 195-9.
[http://dx.doi.org/10.4137/CMAMD.S40401] [PMID: 27891055]
[50]
Fioravanti A, Adamczyk P, Pascarelli NA, et al. Clinical and biochemical effects of a 3-week program of diet combined with spa therapy in obese and diabetic patients: a pilot open study. Int J Biometeorol 2015; 59(7): 783-9.
[http://dx.doi.org/10.1007/s00484-014-0894-5] [PMID: 25194752]
[51]
Forestier R, Genty C, Waller B, et al. Crenobalneotherapy (spa therapy) in patients with knee and generalized osteoarthritis: a post-hoc subgroup analysis of a large multicentre randomized trial. Ann Phys Rehabil Med 2014; 57(4): 213-27.
[http://dx.doi.org/10.1016/j.rehab.2014.03.001] [PMID: 24745692]
[52]
Françon A, Forestier R. [Spa therapy in rheumatology. Indications based on the clinical guidelines of the French National Authority for health and the European League Against Rheumatism, and the results of 19 randomized clinical trials]. Bull Acad Natl Med 2009; 193(6): 1345-56.
[PMID: 20120164]

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