Metabolic abnormalities observed in osteoarthritis of knee: A single center experience

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Osteoarthritis (OA) has become a major public health problem not only because of increasing prevalence worldwide (about 21 million people affected in the United States) but also frequent association with cardiovascular diseases-the leading cause of death in the industrialized countries.

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Metabolic abnormalities observed in osteoarthritis of knee: A single center experience

  1. 1. Metabolic Abnormalities observed in Osteoarthritis of Knee: A single center experience
  2. 2. a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e3 Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/apme Original Article Metabolic abnormalities observed in osteoarthritis of knee: A single center experience Alakes Kumar Kole a,*, Rammohan Roy b, Dalia Chanda Kole c a Associate Professor, Department of Medicine, North Bengal Medical College & Hospital, Darjeeling, West Bengal, India b Clinical Tutor, Department of Medicine, Infectious Diseases Hospital, 57 Beliaghata Main Road, Kolkata 10, India c Senior Consultant, B P Poddar Medical Research & Hospital, New Alipore, Kolkata, India article info abstract Article history: Background: Osteoarthritis is the most common type of joint disease and nowadays obesity- Received 27 June 2013 metabolic syndrome is one of the major risk factors. Accepted 24 September 2013 Aims and objectives: To observe the different metabolic abnormalities in patients with knee Available online xxx osteoarthritis. Patients & methods: A total of 336 patients suffering from knee osteoarthritis were evaluated Keywords: with special reference to different metabolic abnormalities. Osteoarthritis of knee Results: The mean age was 45.8 Æ 14.4 years with male: female ratio was 1:1.2. The meta- Metabolic abnormalities bolic abnormalities observed were e hyperuricemia in 50 (14.9%), metabolic syndrome in Risk factors 43 (12.8%), obesity with dyslipidemia in 28 (8.3%), diabetes with dyslipidemia in 25 (7.4%), obesity in 21 (6.3%), hypothyroidism in 14 (4.2%), diabetes in 13 (3.9%) and dyslipidemia in 10 patients (3%). It had been observed that clustering of metabolic abnormalities were present in younger patients. Conclusion: Osteoarthritis is not only a source of discomfort or misery but also may be associated with various metabolic abnormalities, which are the future predictors of cardiovascular events. Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved. 1. Introduction Osteoarthritis (OA) has become a major public health problem not only because of increasing prevalence worldwide (about 21 million people affected in the United States) but also frequent association with cardiovascular diseases-the leading cause of death in the industrialized countries.1 Osteoarthritis changes is seen in almost all people above 75 years of age whereas at the age of 18e24 years about 7% of men and 2% of women usually show signs of osteoarthritis changes.2 Recent concept is that OA is not merely a disease related to aging or mechanical stress of joints, rather a metabolic disorder sharing similar biochemical as well as inflammatory profile contributing to both the initiation and progression of the disease process.1,3 Hence ‘metabolic osteoarthritis’ may be considered as a subtype of OA and also the fifth component of metabolic * Corresponding author. Resident address: Victoria Greens, Flat-A3/204, 385 Garia Main Road, Kolkata 700084, West Bengal, India. Tel.: þ91 (0) 9830056291. E-mail addresses: dralakeskole72@gmail.com, dralakeskole@yahoo.co.in (A.K. Kole), royrammohan@yahoo.com (R. Roy), drdaliachanda77@yahoo.co.in (D.C. Kole). 0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2013.09.001 Please cite this article in press as: Kole AK, et al., Metabolic abnormalities observed in osteoarthritis of knee: A single center experience, Apollo Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.09.001
  3. 3. 2 a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e3 syndrome.4 It had been reported that obesity is one of the major modifiable risk factors attributing to the development of knee osteoarthritis (elevated adipokines) by inducing the expression of proinflammatory factors as well as degradative enzymes leading to the inhibition of cartilage matrix synthesis and stimulation of subchondral bone remodeling.5 Hyperglycemia (advanced glycation end-products), by oxidative stress and also by inducing low-grade systemic inflammation, is responsible for cartilage damage, whereas dyslipidemia may initiate development of OA due to abnormal lipid metabolism (ectopic lipid deposition). Moreover, hypertension can cause subchondral ischemia compromising nutrient exchange and triggering bone remodeling leading to osteoarthritis. Metabolic syndrome was reported to be more prevalent in younger individuals suffering from knee osteoarthritis regardless of sex or race and the development of osteoarthritis at the age of 44 years was associated with a five fold increased risk of metabolic syndrome.6 Moreover, presence of more than one metabolic risk factors was associated with more chances of development and also progression of knee osteoarthritis.7 A recent study showed that patients suffering from knee OA had twofold increased risk of availing sick leave and also 40e50% increased risk of disability pension benefit compared to the general population.8 Moreover osteoarthritis, particularly in the younger individuals, is really a source of discomfort and misery, often due to the fact that it prevents and hinders an otherwise healthy individual taking part in activities they might usually enjoy due to its significant impact on quality of life.9 The objective of this study was to observe different metabolic abnormalities in patients suffering from knee osteoarthritis. Table 1 e Different metabolic abnormalities in patients with knee OA. Risk factors Hyperuricemia Metabolic syndrome Obesity þ dyslipidemia Diabetes þ dyslipidemia Obesity Hypothyroidism Diabetes Dyslipidemia Patients and methods This was a cross sectional observational study done in North Bengal Medical College & Hospital, Darjeeling, India from January ’2009 to January ’2011. A total number of 342 patients suffering from knee osteoarthritis (diagnosed as per the ACR criteria) were randomly selected from rheumatology clinic and six of them were excluded because of recent history of trauma to knee joint. The enrolled patients were evaluated in respect to their complaints, occupation, food habits, body mass index (BMI), waist hip ratio, blood pressure, and any history of operation or injury involving knee joints in past or any congenital bony abnormality. Blood biochemistry including fasting blood glucose, serum uric acid, lipid profile and thyroid function tests were done. Consent for this study was taken from each patient and ethical approval done. Data were collected and analyzed in respect to different metabolic abnormalities and metabolic syndrome was diagnosed as per National Cholesterol Education Program (NCEP-ATPIII) criteria. 3. Results In this study the mean age was 45.8 Æ 14.4 years with the male: female ratio was 1:1.2 and the mean BMI was 24.34 Æ 4.45 kg/ m2. The occupation of these patients were office workers -112 50 43 28 25 21 14 13 10 (14.9%) (12.8%) (8.3%) (7.4%) (6.3%) (4.2%) (3.9%) (3%) (33.3%), shopkeepers -95 (28.2%), labors -39 (11.6%), retired persons -33 (9.8%), farmers -27 (8%), house wives -21 (6.2%) and students -9 (2.7%). Majority of these patients were observed to have history of consumption of high calorie diet and less physical activity. The different metabolic abnormalities observed were e metabolic syndrome in 43 (12.8%), obesity and dyslipidemia in 28 (8.3%), diabetes and dyslipidemia in 25 (7.4%), obesity in 21 (6.3%), hypothyroidism in 14 (4.2%), diabetes in 13 (3.9%) and dyslipidemia in 10 patients (3%) [Table 1]. The mean triglyceride level was 221.24 Æ 58.56 mg/dl, HDL was 32 Æ 4.2 mg/dl, LDL level was 112 Æ 24.56 mg/dl and mean uric acid was 6.8 ± 1.3 mg/dl. The other co morbidities/ inflammatory diseases /events observed were e hypertension in 36 (10.7%), past history of knee joint injury/operation in 19 (5.6%), inflammatory joint diseases in 12 cases (3.6%) [rheumatoid arthritis in 8, ankylosing spondylitis in 3 and mixed connective tissue disease in one]. 4. 2. No of patients (%) Discussion In this study it had been observed that metabolic abnormalities were present in different combinations in a total of 46% of patients suffering from knee OA and importantly clustering of these metabolic abnormalities were present below 50 years of age group (26%) which was epidemiologically significant. Hyperuricemia was the most common metabolic abnormality observed in this study and it had been reported that high serum uric acid was associated with metabolic syndrome and its components.10 Metabolic syndrome was detected in 12.8% patients and they were mainly office workers or shopkeepers with sedentary lifestyle. Moreover, it had been also observed that majority of these patients had suffered much from pain, stiffness and restricted movement of knees requiring repeated outpatient visit, long absence from works particularly in younger patients and also hampering social activities. Diabetes and primary hypothyroidism were the two major endocrine disorders observed in 3.9% and 4.2% cases of knee OA in this study and strict control of these abnormalities are essential to control OA. Though in this present study metabolic abnormalities were not so uncommon but more population based studies are needed to establish whether these are merely associated or as risk factors for knee OA. Hence, maintaining ideal body weight along with regular exercise and consumption of low calorie/high fiber diet are all may be considered as primordial prevention for development of metabolic abnormalities. Moreover continuous Please cite this article in press as: Kole AK, et al., Metabolic abnormalities observed in osteoarthritis of knee: A single center experience, Apollo Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.09.001
  4. 4. a p o l l o m e d i c i n e x x x ( 2 0 1 3 ) 1 e3 counseling with reinforcement for weight loss in already obese individuals along with regular metabolic screening and appropriate management of already developed metabolic abnormalities are all the essential steps in patients suffering from osteoarthritis of knee to decrease future cardiovascular events and also possibly the development and/or progression of osteoarthritis. Conflicts of interest All authors have none to declare. references 1. Velasquez MT, Katz JD. Osteoarthritis: another component of metabolic syndrome? Metab Syndr Relat Disord. 2010;8(4):295e305. 2. Roberts J, Burch TA. Osteoarthritis prevalence in adults by age, sex, race, and geographic area. Vital Health Stat. 1966;15:1e27. 3 3. Katz JD, Agrawal S, Velasquez M. Getting to the heart of the matter: osteoarthritis takes its place as part of the metabolic syndrome. Curr Opin Rheumatol. 2010;22(5):512e519. 4. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012;8(12):729e737. 5. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in the general population: the Chingford study. J Rheumatol. 1993;20:331e335. 6. Puenpatom RA, Victor TW. Increased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III data. Postgrad Med. 2009;121(6):9e20. 7. Yoshimura N, Muraki S, Oka H, et al. Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: a 3-year follow-up of the ROAD study. Osteoarthritis and Cartilage. 2012;20(11):1217e1226. 8. Hubertsson J, Petersson IF, Thorstensson CA. Risk of sick leave and disability pension in working-age women and men with knee osteoarthritis. Englund MAnn Rheum Dis. 2013;72(3):401e405. 9. Woo J, Lau E, Lee P, et al. Impact of osteoarthritis on quality of life in a Hong Kong Chinese population. J Rheumatol. 2004;31(12):2433e2438. 10. Chen LY, Zhu WH, Chen ZW, et al. Relationship between hyperuricemia and metabolic syndrome. J Zhejiang Univ Sci B. 2007;8(8):593e598. Please cite this article in press as: Kole AK, et al., Metabolic abnormalities observed in osteoarthritis of knee: A single center experience, Apollo Medicine (2013), http://dx.doi.org/10.1016/j.apme.2013.09.001
  5. 5. A o oh s i l ht:w wa o o o p a . m/ p l o p a : t / w .p l h s i lc l ts p / l ts o T ie: t s / ie. m/o p a A o o wt rht :t t r o H s i l p l t p /w t c ts l Y uu e ht:w wy uu ec m/p l h s i ln i o tb : t / w . tb . a o o o p a i a p/ o o l ts d F c b o : t :w wfc b o . m/h A o o o p a a e o k ht / w . e o k o T e p l H s i l p/ a c l ts Si s ae ht:w wsd s aen t p l _ o p a l e h r: t / w .i h r.e/ o o H s i l d p/ le A l ts L k d : t :w wl k d . m/ mp n /p l -o p a i e i ht / w . e i c c a y o oh s i l n n p/ i n no o a l ts Bo : t :w wl s l e l . / l ht / w . t a h a hi g p/ e tk t n

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