The association of obesity with osteoarthritis of the hand and knee in women: A twin study

Department of Rheumatology, St. Thomas' Hospital, Guys' and St. Thomas' Trust, London, UK.
The Journal of Rheumatology (Impact Factor: 3.19). 08/1996; 23(7):1221-6.
Source: PubMed

ABSTRACT To examine the association of obesity and osteoarthritis (OA) at various sites in middle aged women and to estimate the magnitude of the weight difference associated with OA.
A co-twin control study was performed within a population based twin study of women aged 48-70. OA was defined radiologically using site specific features and a standard atlas. Twin pairs discordant for OA disease traits were analyzed.
The mean weight differences (95% CI) within twin pairs discordant for different OA traits were: tibiofemoral osteophytes 3.75 (1.29, 6.21) kg; patellofemoral osteophytes 3.05 (0.96, 5.15) kg; carpometacarpal (CMC) osteophytes 3.06 (0.83, 5.28) kg. There was no significant difference in weight within twin pairs discordant for osteophytes at the distal interphalangeal (DIP) or proximal interphalangeal (PIP) joints or for joint space narrowing at all sites examined except the patellofemoral joint, 4.73 (1.61, 7.84) kg. For each kg increase in weight the increased likelihood of developing different OA traits [OR (95% CI)] was: tibiofemoral osteophytes 1.14 (1.01-1.28), patellofemoral osteophytes 1.32 (1.09-1.59), patellofemoral narrowing 1.15 (1.01-1.30), and CMC osteophytes 1.09 (1.02-1.17).
Obesity is an important risk factor for development of OA at the tibiofemoral and patellofemoral joints of the knee and CMC joints of the hands, with significant increases of 9-13% in risk of OA per kg increase in body weight. This emphasizes the potential importance of even minor weight reduction as a preventive health measure for OA.

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    • "Overweight or obesity substantially raises a patient's risk of morbidity from hypertension [1] [2], type 2 diabetes [3] [4], dyslipidemia [5], cardiovascular disease (CVD) [5], stroke [6], gallbladder disease [7], osteoarthritis [8], sleep apnea, respiratory problems [9] [10], and also endometrial, breast, prostate, and colon cancers [11]. Overweight and obesity are a major public health concern not only in western countries but also in Asian countries because of its increasing prevalence and its association to morbidity and mortality [12] [13]. "
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    ABSTRACT: We investigated the effects of herbal extracts, a mixture of Scutellariae Radix and Platycodi Radix containing the active ingredients Baicalin and Saponin (target herbal ingredient (THI)), on lowering body weight. The present study was a prospective, randomized, double-blind, and placebo-controlled trial carried out at the outpatient department of a hospital over a period of 2 months. Group 1 patients (n = 30) received THI, and group 2 patients (n = 23) received placebo three times a day before meals. Weight, waist circumference, BMI, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and glucose were measured at baseline and again at the 2nd month. For safety evaluation, various hematological and biochemical parameters were assessed. Values of mean change of weight in the THI-treated group were -1.16 ± 1.41 kg and in the placebo-treated group were -0.24 ± 1.70 kg, respectively. The difference in mean change of weight in the THI-treated group compared with that in the placebo-treated group was statistically significant (P < 0.05). The incidence of subjective and objective adverse drug reactions was insignificant (P > 0.05). THI was statistically significant in its effectiveness on the weight loss.
    Evidence-based Complementary and Alternative Medicine 10/2013; 2013:758273. DOI:10.1155/2013/758273 · 1.88 Impact Factor
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    • "Although women have a greater risk of developing hand OA than men [51,52], a study that included both men and women showed a significant association between body weight and hand OA in men but not women [53], whereas a separate study of women only demonstrated that body weight was a significant predictor of incident hand OA [50]. Increasing evidence suggests that metabolic factors related to obesity, now regarded as a low-grade systemic inflammatory disease, influence systemic levels of cytokines, which interact with mechanical factors in the development of OA [54-57]. Individuals with OA have higher concentrations of leptin in synovial fluid and these levels are significantly correlated with BMI [58]. "
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    ABSTRACT: The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and obesity on sex differences in knee OA. Observational data suggest that limb alignment can predict the development of radiographic signs of knee OA, potentially due to increased stresses and strains within the joint. However, these data do not indicate how limb alignment could contribute to sex differences in either the development or worsening of knee OA. Similarly, the strength of the knee extensor muscles is compromised in women who develop radiographic and symptomatic signs of knee OA, but the extent to which the decline in muscle function precedes the development of the disease is uncertain. Even less is known about how changes in muscle function might contribute to the worsening of knee OA. Conversely, obesity is a stronger predictor of developing knee OA symptoms in women than in men. The influence of obesity on developing knee OA symptoms is not associated with deviation in limb alignment, but BMI predicts the worsening of the symptoms only in individuals with neutral and valgus (knock-kneed) knees. It is more likely, however, that obesity modulates OA through a combination of systemic effects, particularly an increase in inflammatory cytokines, and mechanical factors within the joint. The absence of strong associations of these surrogate measures of the mechanical environment in the knee joint with sex differences in the development and progression of knee OA suggests that a more multifactorial and integrative approach in the study of this disease is needed. We identify gaps in knowledge related to mechanical influences on the sex differences in knee OA.
    Biology of Sex Differences 12/2012; 3(1):28. DOI:10.1186/2042-6410-3-28 · 4.84 Impact Factor
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    • "At the knee joint, where obesity increases the risk of developing osteoarthritis by twofold to 10-fold [1,2], local biomechanical factors associated with body mass index, limb alignment, and quadriceps muscle strength can all influence both the onset and progression of knee osteoarthritis [3-5]. Nevertheless, these factors do not explain the association between obesity and osteoarthritis at nonload-bearing joints [2,6,7], and suggest that, in certain cases, systemic factors may be involved in the onset or progression of the disease. "
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    ABSTRACT: Obesity is a major risk factor for the development of osteoarthritis in both weight-bearing and nonweight-bearing joints. The mechanisms by which obesity influences the structural or symptomatic features of osteoarthritis are not well understood, but may include systemic inflammation associated with increased adiposity. In this study, we examined biomechanical, neurobehavioral, inflammatory, and osteoarthritic changes in C57BL/6J mice fed a high-fat diet. Female C57BL/6J mice were fed either a 10% kcal fat or a 45% kcal fat diet from 9 to 54 weeks of age. Longitudinal changes in musculoskeletal function and inflammation were compared with endpoint neurobehavioral and osteoarthritic disease states. Bivariate and multivariate analyses were conducted to determine independent associations with diet, percentage body fat, and knee osteoarthritis severity. We also examined healthy porcine cartilage explants treated with physiologic doses of leptin, alone or in combination with IL-1α and palmitic and oleic fatty acids, to determine the effects of leptin on cartilage extracellular matrix homeostasis. High susceptibility to dietary obesity was associated with increased osteoarthritic changes in the knee and impaired musculoskeletal force generation and motor function compared with controls. A high-fat diet also induced symptomatic characteristics of osteoarthritis, including hyperalgesia and anxiety-like behaviors. Controlling for the effects of diet and percentage body fat with a multivariate model revealed a significant association between knee osteoarthritis severity and serum levels of leptin, adiponectin, and IL-1α. Physiologic doses of leptin, in the presence or absence of IL-1α and fatty acids, did not substantially alter extracellular matrix homeostasis in healthy cartilage explants. These results indicate that diet-induced obesity increases the risk of symptomatic features of osteoarthritis through changes in musculoskeletal function and pain-related behaviors. Furthermore, the independent association of systemic adipokine levels with knee osteoarthritis severity supports a role for adipose-associated inflammation in the molecular pathogenesis of obesity-induced osteoarthritis. Physiologic levels of leptin do not alter extracellular matrix homeostasis in healthy cartilage, suggesting that leptin may be a secondary mediator of osteoarthritis pathogenesis.
    Arthritis research & therapy 07/2010; 12(4):R130. DOI:10.1186/ar3068 · 3.75 Impact Factor
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