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Wednesday, 13 August 2014

Obesity Complication of Osteoarthritis

By Kyle J. Norton

Obesity is defined as a medical condition of excess body fat accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

Osteoarthritis (Degeneration Joint Disease) is  the most common joint disorder and defined as a condition of degeneration of joints, including non infectious progression of degeneration of articular cartilage and subchondral bone, leading to pain in the area.

How Obesity associates with Osteoarthritis
1. According to the study of "
Induction of osteoarthritis and metabolic inflammation by a very high fat diet in mice: Effects of short-term exercise" Griffin TM, Huebner JL, Kraus VB, Yan Z, Guilak F., posted in PubMed, researchers concluded that Obesity induced by a very high-fat diet causes osteoarthritis and systemic inflammation in proportion to body fat. Increased joint loading is not sufficient to explain the increased incidence of knee osteoarthritis with obesity as wheel running is protective rather than damaging. Exercise improves glucose tolerance and disrupts the co-expression of pro-inflammatory cytokines, suggesting that increased aerobic exercise may act independent of weight loss in promoting joint health.

2. In an abstract of the study of "Does obesity predict knee pain over fourteen years in women, independently of radiographic changes?" by Goulston LM, Kiran A, Javaid MK, Soni A, White KM, Hart DJ, Spector TD, Arden NK., posted in PubMed, researchers found that Over 14 years, a higher BMI predicts knee pain at Y15 in women, independently of radiographic knee OA. When adjusted, the association was significant in bilateral, not unilateral, knee pain, suggesting alternative pathologic mechanisms may exist. The longitudinal effect of BMI on knee pain at Y15 is equally important at any time point, which may assist reducing the population burden of knee pain.

3. In the study of "The association of BMI and knee pain among persons with radiographic knee osteoarthritis: a cross-sectional study" by Rogers MW, Wilder FV., posted in PubMed, researchers concluded that Among subjects with RKOA, those presenting with an elevated BMI had a greater likelihood of knee pain compared to subjects with a normal BMI, and this chance rose with each successive elevated BMI category. As BMI is a modifiable risk factor, longitudinal research is needed to confirm these findings and elucidate the mechanisms underlying this relationship.

4. According to the study of "Anthropometric measures, body composition, body fat distribution, and knee osteoarthritis in women" by Abbate LM, Stevens J, Schwartz TA, Renner JB, Helmick CG, Jordan JM., posted in PubMed, researchers indicated that This study confirms that BMI and weight are strongly associated with rKOA in women and suggests that precise measurements of body composition and measures of fat distribution may offer no advantage over the more simple measures of BMI or weight in assessment of risk of rKOA.

5. In the study of "Case-control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload" by Vrezas I, Elsner G, Bolm-Audorff U, Abolmaali N, Seidler, A., posted in PubMed, researchers found that In accordance with the literature, we find a strong association between BMI and knee osteoarthritis risk. Considering the relatively high prevalence of occupational manual materials handling, prevention of knee osteoarthritis should not only focus on body weight reduction, but should also take into account work organizational measures particularly aiming to reduce occupational lifting and carrying of loads.

6. According to the abstract of the study of "The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study" by Hart DJ, Spector TD., posted in PubMed, researchers filed conclusion that Our results confirm that excess body weight is a powerful predictor of OA of the knee in middle aged women, and a modest predictor of DIP and CMC OA.

7. Etc.

 Treatments of Obesity and Osteoarthritis
1. According to the Finnish study of "[Update on current care guidelines: management of adult obesity]" [Article in Finnish] by Suomalaisen Lääkäriseuran Duodecimin; Suomen Lihavuustutkijat RY:n Asettama Työryhmä., posted in PubMed, researchers indicated that The aim of treatment is to prevent and alleviate obesity comorbidities (e.g. type 2 diabetes, cardiovascular diseases, sleep apnoea and osteoarthritis) through a permanent weight reduction of at least 5%. The core element in management is lifestyle counselling on eating and exercise behaviours.

2. In the study of "Update in surgery for osteoarthritis of the knee" by Choong PF, Dowsey MM., posted in PubMed, researchers found that Obesity is a health priority in developed countries where it is overrepresented in patients presenting for joint replacement. Complications, poor patient satisfaction and joint function can be directly attributable to obesity. Efforts to address obesity should be considered as part of the approach to managing osteoarthritis.

3. In the abstract of the study of "What of guidelines for osteoarthritis?" by Lim AY, Doherty M., posted in PubMed, researchers indicated that guideline development groups vary in terms of process and structure of guideline production and in how much integration there is between research, expert and patient evidence. Nevertheless, guidelines on OA concur in recommending: holistic assessment of the patient and individualizing the management plan; patient information access; weight loss if overweight or obese, and prescription of exercise. Additional adjunctive non-pharmacological and pharmacological interventions, including surgery, may be added to this core set as required. However, when audited, it appears that management of OA is often suboptimal, with a major focus on oral analgesics, especially non-steroidal anti-inflammatory drugs. A number of barriers to implementation are evident and appropriate audit of care is necessary to improve delivery of service and to plan healthcare resources. For OA, the effect size of placebo in clinical trials is usually far greater than the additional specific effect of individual treatments, emphasizing the importance of contextual ('meaning') response in this chronic painful condition. This has important implications for clinical care in that optimization of the contextual response can lead to improvements in patient outcomes even in the absence of very effective treatments.

4. Etc.
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