Obesity leads to many health problems and it has long been established as the number one preventable risk factor for the development of osteoarthritis. Many recent studies on knee osteoarthritis illustrate this and research has shown that the need for knee replacement steadily increases with weight gain.[1] The reason for this has generally been assumed to be due to the additional load on the joints that carry weight but is this the complete picture or is there more to the link between obesity and osteoarthritis?
Wear and Tear
It is true that a high body mass index causes increased strain on the knee and other load-bearing joints.[2] In addition, overweight people tend to have an abnormal posture and gait which puts additional stress on joints leading to wearing of articular cartilage (the tissue that covers and protects the joints).[3] The subchondral bone is also affected by the additional mechanical stress of weight gain and thickening of the bone results.
Unhealthy Lipid Balance
Since obese people often also have osteoarthritis in non-load-bearing joints such as the hands, medical researchers began to wonder whether there were more mechanisms at play than simply excessive joint load. Lipid metabolism then came under the spotlight as a possible cause. Obese individuals often have abnormal lipid levels in the blood, these being high plasma levels of triglycerides, high levels of free fatty acids and low levels of HDL cholesterol which scavenges unhealthy cholesterol and other lipids from the body. These imbalances can lead to heart disease but various studies have shown that lipid balance can play a role in the development of osteoarthritis as well.[4] High serum total cholesterol has been associated with painful bone marrow lesions which can lead to cartilage loss in knee osteoarthritis, in particular.[5] Another finding is that arthritic cartilage tends to accumulate lipids and the more severe the case of osteoarthritis the higher the incidence of these lipids, throwing out lipid balance.[6]
Tissue Inflammation
Another common characteristic of those with obesity is high levels of inflammation of adipose tissue which is the connective tissue used to produce and store fat in the body. Adipose tissue in obese individuals tends to secrete high levels pro-inflammatory adipokines and cytokines (immune proteins) that can induce low grade chronic inflammation throughout the body. This environment can have a detrimental effect on joint tissue, aiding the development of osteoarthritis.[7]
Treatment of Osteoarthritis
With these new findings in mind, it is more clear than ever that losing weight can have a direct and positive impact on the progression of osteoarthritis. Among people with osteoarthritis, weight reduction strategies can potentially reduce the need for operations such as knee replacements and slow down the worsening of painful symptoms.[8]
Therefore, an osteoarthritis management plan for overweight individuals should always include weight loss through lifestyle changes. An improved diet is needed that cuts back on dietary fat and total calories as well as a commitment to moderate, regular exercise that will not only assist with weight loss but help with joint mobility as well. Other treatment options to aid pain relief are physical therapy, application of heat or cold in affected areas, pain killers and supplements that are proven to reduce joint inflammation.
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References:
- Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol 1988;179_89.
- Widmyer MR, Utturkar GM, Leddy HA et al. High body mass index is associated with increased diurnal strains in the articular cartilage of the knee. Arthritis Rheum 2013;65:2615_22.
- Radin EL, Paul IL, Rose RM. Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1972;1:519_22.
- Sturmer T, Sun Y, Sauerland S et al. Serum cholesterol and osteoarthritis. The baseline examination of the Ulm
- Osteoarthritis Study. J Rheumatol 1998;25:1827_32. Davies-Tuck ML, Hanna F, Davis SR et al. Total cholesterol and triglycerides are associated with the development of new bone marrow lesions in asymptomatic middle-aged women _ a prospective cohort study. Arthritis Res Ther 2009;11:R181.
- Lippiello L, Walsh T, Fienhold M. The association of lipid abnormalities with tissue pathology in human osteoarthritic articular cartilage. Metabolism 1991;40:571_6.
- Lumeng CN, Bodzin JL, Saltiel AR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest 2007;117:175_84.
- http://www.medscape.com/viewarticle/863805
