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The metabolic syndrome’s association with the development of osteoarthritis appears to occur primarily through the influence of factors related to body weight or body mass index, according to an analysis of data from the longitudinal Framingham osteoarthritis study.
Jingbo Niu, DSc, of the Clinical Epidemiology Research and Training Unit at Boston University, and her colleagues found that while the presence of the metabolic syndrome (MetS) and its individual components – central obesity, dyslipidemia, impaired fasting glucose, and hypertension – were associated with a risk of both radiographic osteoarthritis (ROA) and symptomatic OA (SxOA), all associations besides high blood pressure (particularly diastolic blood pressure) disappeared after they adjusted for body mass index (BMI) or body weight (Arthritis Rheumatol. 2017 Mar 3. doi: 10.1002/art.40087).
The research team analyzed 991 participants of the 1992-1995 Framingham Offspring Cohort who did not have existing OA at baseline. Average age was 54.2 years; 55.1% were women. According to Adult Treatment Panel III criteria, 27% of the men and 23% of the women had MetS. Those who had MetS were older, had a higher BMI, and were less likely to drink alcohol or have a college education.
In 2002-2005, the cohort underwent follow-up for the presence of OA. The incidence of ROA in the cohort was 9.8% (78 of 800 knees) in men and 10.5% (105 of 1,003 knees) in women. ROA occurred when a knee without previous radiographic evidence of OA developed a Kellgren and Lawrence score of 2 or higher, and SxOA occurred when a knee developed ROA together with knee pain.
After adjusting for age, education, smoking status, alcohol consumption, and physical activity, the researchers found that MetS, abdominal obesity, and low high-density lipoprotein cholesterol were significantly associated with incident ROA among men. Among women, abdominal obesity and high blood pressure were associated with incident ROA, while MetS was not. However, after adjustment for body weight or BMI, none of the associations remained significant.
The incidence of SxOA was 6.3% (53 of 837 knees) in men and 7.2% (75 of 1,037 knees) in women. Incident SxOA was significantly associated with MetS in women and with the MetS components of abdominal obesity and high blood pressure in both men and women before adjustment for BMI or body weight. However, only an association between diastolic blood pressure and incident SxOA persisted in both sexes after adjustment for body weight, the study authors noted.
“High blood pressure is another MetS component associated with OA in previous studies before adjusting for BMI ... While we found [diastolic blood pressure] was related to incident SxOA even after adjustment for BMI, the relation of [systolic blood pressure] and incident SxOA was nearly significant also, suggesting that both might be related to SxOA,” the study authors wrote.
But a cross-sectional analysis of the relationship would be challenging to interpret, they said, since treatment for SxOA included NSAIDs, which are known to raise blood pressure.
The National Institutes of Health supported the study. The authors declared having no conflicts of interest.
The OA incidence reported in the Framingham study is particularly noteworthy because it shows that preexisting MetS and its components are risk factors for subsequent symptomatic OA and not just radiographic OA, which seems to indicate the existence of common risk factors for both MetS and OA in a manner such that OA could be just a late-occurring component of MetS.
But it may be most appropriate to consider metabolic OA as a complication of MetS, similar to cardiovascular disease.
The fact that any component of MetS remained significantly associated with symptomatic OA after adjustment for BMI and body weight argued strongly for a metabolic driver of OA pathophysiology when considering the likely confounding of body weight between mechanical and metabolic processes.
Nevertheless, carefully designed studies are needed to determine the relative impact of increased body mass in MetS on joint loading versus metabolic derangements, including systemic inflammation, to rule in or out the effects of altered metabolism on incident OA risk independent of biomechanics.
This knowledge would help a great deal toward understanding metabolic OA and other phenotypes as well as for the development of rational treatment approaches.
Thomas Appleton, MD, PhD, of Western University in London, Ont., and his colleagues made these comments in an editorial (Arthritis Rheumatol. 2017 Mar 7. doi: 10.1002/art.40089). They declared having no conflicts of interest to relevant to their editorial.
The OA incidence reported in the Framingham study is particularly noteworthy because it shows that preexisting MetS and its components are risk factors for subsequent symptomatic OA and not just radiographic OA, which seems to indicate the existence of common risk factors for both MetS and OA in a manner such that OA could be just a late-occurring component of MetS.
But it may be most appropriate to consider metabolic OA as a complication of MetS, similar to cardiovascular disease.
The fact that any component of MetS remained significantly associated with symptomatic OA after adjustment for BMI and body weight argued strongly for a metabolic driver of OA pathophysiology when considering the likely confounding of body weight between mechanical and metabolic processes.
Nevertheless, carefully designed studies are needed to determine the relative impact of increased body mass in MetS on joint loading versus metabolic derangements, including systemic inflammation, to rule in or out the effects of altered metabolism on incident OA risk independent of biomechanics.
This knowledge would help a great deal toward understanding metabolic OA and other phenotypes as well as for the development of rational treatment approaches.
Thomas Appleton, MD, PhD, of Western University in London, Ont., and his colleagues made these comments in an editorial (Arthritis Rheumatol. 2017 Mar 7. doi: 10.1002/art.40089). They declared having no conflicts of interest to relevant to their editorial.
The OA incidence reported in the Framingham study is particularly noteworthy because it shows that preexisting MetS and its components are risk factors for subsequent symptomatic OA and not just radiographic OA, which seems to indicate the existence of common risk factors for both MetS and OA in a manner such that OA could be just a late-occurring component of MetS.
But it may be most appropriate to consider metabolic OA as a complication of MetS, similar to cardiovascular disease.
The fact that any component of MetS remained significantly associated with symptomatic OA after adjustment for BMI and body weight argued strongly for a metabolic driver of OA pathophysiology when considering the likely confounding of body weight between mechanical and metabolic processes.
Nevertheless, carefully designed studies are needed to determine the relative impact of increased body mass in MetS on joint loading versus metabolic derangements, including systemic inflammation, to rule in or out the effects of altered metabolism on incident OA risk independent of biomechanics.
This knowledge would help a great deal toward understanding metabolic OA and other phenotypes as well as for the development of rational treatment approaches.
Thomas Appleton, MD, PhD, of Western University in London, Ont., and his colleagues made these comments in an editorial (Arthritis Rheumatol. 2017 Mar 7. doi: 10.1002/art.40089). They declared having no conflicts of interest to relevant to their editorial.
The metabolic syndrome’s association with the development of osteoarthritis appears to occur primarily through the influence of factors related to body weight or body mass index, according to an analysis of data from the longitudinal Framingham osteoarthritis study.
Jingbo Niu, DSc, of the Clinical Epidemiology Research and Training Unit at Boston University, and her colleagues found that while the presence of the metabolic syndrome (MetS) and its individual components – central obesity, dyslipidemia, impaired fasting glucose, and hypertension – were associated with a risk of both radiographic osteoarthritis (ROA) and symptomatic OA (SxOA), all associations besides high blood pressure (particularly diastolic blood pressure) disappeared after they adjusted for body mass index (BMI) or body weight (Arthritis Rheumatol. 2017 Mar 3. doi: 10.1002/art.40087).
The research team analyzed 991 participants of the 1992-1995 Framingham Offspring Cohort who did not have existing OA at baseline. Average age was 54.2 years; 55.1% were women. According to Adult Treatment Panel III criteria, 27% of the men and 23% of the women had MetS. Those who had MetS were older, had a higher BMI, and were less likely to drink alcohol or have a college education.
In 2002-2005, the cohort underwent follow-up for the presence of OA. The incidence of ROA in the cohort was 9.8% (78 of 800 knees) in men and 10.5% (105 of 1,003 knees) in women. ROA occurred when a knee without previous radiographic evidence of OA developed a Kellgren and Lawrence score of 2 or higher, and SxOA occurred when a knee developed ROA together with knee pain.
After adjusting for age, education, smoking status, alcohol consumption, and physical activity, the researchers found that MetS, abdominal obesity, and low high-density lipoprotein cholesterol were significantly associated with incident ROA among men. Among women, abdominal obesity and high blood pressure were associated with incident ROA, while MetS was not. However, after adjustment for body weight or BMI, none of the associations remained significant.
The incidence of SxOA was 6.3% (53 of 837 knees) in men and 7.2% (75 of 1,037 knees) in women. Incident SxOA was significantly associated with MetS in women and with the MetS components of abdominal obesity and high blood pressure in both men and women before adjustment for BMI or body weight. However, only an association between diastolic blood pressure and incident SxOA persisted in both sexes after adjustment for body weight, the study authors noted.
“High blood pressure is another MetS component associated with OA in previous studies before adjusting for BMI ... While we found [diastolic blood pressure] was related to incident SxOA even after adjustment for BMI, the relation of [systolic blood pressure] and incident SxOA was nearly significant also, suggesting that both might be related to SxOA,” the study authors wrote.
But a cross-sectional analysis of the relationship would be challenging to interpret, they said, since treatment for SxOA included NSAIDs, which are known to raise blood pressure.
The National Institutes of Health supported the study. The authors declared having no conflicts of interest.
The metabolic syndrome’s association with the development of osteoarthritis appears to occur primarily through the influence of factors related to body weight or body mass index, according to an analysis of data from the longitudinal Framingham osteoarthritis study.
Jingbo Niu, DSc, of the Clinical Epidemiology Research and Training Unit at Boston University, and her colleagues found that while the presence of the metabolic syndrome (MetS) and its individual components – central obesity, dyslipidemia, impaired fasting glucose, and hypertension – were associated with a risk of both radiographic osteoarthritis (ROA) and symptomatic OA (SxOA), all associations besides high blood pressure (particularly diastolic blood pressure) disappeared after they adjusted for body mass index (BMI) or body weight (Arthritis Rheumatol. 2017 Mar 3. doi: 10.1002/art.40087).
The research team analyzed 991 participants of the 1992-1995 Framingham Offspring Cohort who did not have existing OA at baseline. Average age was 54.2 years; 55.1% were women. According to Adult Treatment Panel III criteria, 27% of the men and 23% of the women had MetS. Those who had MetS were older, had a higher BMI, and were less likely to drink alcohol or have a college education.
In 2002-2005, the cohort underwent follow-up for the presence of OA. The incidence of ROA in the cohort was 9.8% (78 of 800 knees) in men and 10.5% (105 of 1,003 knees) in women. ROA occurred when a knee without previous radiographic evidence of OA developed a Kellgren and Lawrence score of 2 or higher, and SxOA occurred when a knee developed ROA together with knee pain.
After adjusting for age, education, smoking status, alcohol consumption, and physical activity, the researchers found that MetS, abdominal obesity, and low high-density lipoprotein cholesterol were significantly associated with incident ROA among men. Among women, abdominal obesity and high blood pressure were associated with incident ROA, while MetS was not. However, after adjustment for body weight or BMI, none of the associations remained significant.
The incidence of SxOA was 6.3% (53 of 837 knees) in men and 7.2% (75 of 1,037 knees) in women. Incident SxOA was significantly associated with MetS in women and with the MetS components of abdominal obesity and high blood pressure in both men and women before adjustment for BMI or body weight. However, only an association between diastolic blood pressure and incident SxOA persisted in both sexes after adjustment for body weight, the study authors noted.
“High blood pressure is another MetS component associated with OA in previous studies before adjusting for BMI ... While we found [diastolic blood pressure] was related to incident SxOA even after adjustment for BMI, the relation of [systolic blood pressure] and incident SxOA was nearly significant also, suggesting that both might be related to SxOA,” the study authors wrote.
But a cross-sectional analysis of the relationship would be challenging to interpret, they said, since treatment for SxOA included NSAIDs, which are known to raise blood pressure.
The National Institutes of Health supported the study. The authors declared having no conflicts of interest.
FROM ARTHRITIS & RHEUMATOLOGY
Key clinical point: There is no strong association between the metabolic syndrome (MetS) and OA after adjustment for BMI or body weight.
Major finding: Components of MetS were initially associated with incident radiographic and symptomatic OA, but after adjustment for BMI or body weight, most of the associations were weak and insignificant. However, an association between the MetS and high blood pressure persisted in both sexes.
Data source: An analysis of 991 participants of the 1992-1995 Framingham Offspring Cohort who did not have existing OA at baseline and were followed for 10 years.
Disclosures: The National Institutes of Health supported the study. The authors declared having no conflicts of interest.