Relationship between metabolic syndrome and osteoarthritis: The Fasa Osteoarthritis Study

The impact of sericin on inflammation, oxidative stress, and lipid metabolism in female rats with experimental knee osteoarthritis

OBJECTIVE

This study investigated the effects of sericin on inflammation, oxidative stress, and lipid metabolism in female rats with experimental knee osteoarthritis (KOA), focusing on evaluating its effectiveness via the sterol regulatory protein (SREBP)-1C and SREBP-2 pathways.

METHODS

The rats were randomly assigned to three experimental groups: the C group (control), the KOA group (KOA control), and the sericin group (KOA + sericin). The KOA model was created by injecting monosodium iodoacetate (MIA) into the knee joint. Sericin was administered intra-articularly to rats on days 1, 7, 14, and 21 (0.8 g/kg/mL, 50 µL). After 21 days, the rats were sacrificed, and serum samples were analyzed using an ELISA to measure tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-10, SREBP-1c, SREBP-2, acetyl-CoA carboxylase (ACC), fatty acid synthase (FAS), cholesterol, triglyceride, and total oxidant-antioxidant status (TOS-TAS) levels.

RESULTS

The KOA group exhibited higher serum TNF-α, IL-1β, TOS, SREBP-1C, ACC, FAS, triglyceride, SREBP-2, and cholesterol levels than the C group (P < 0.05). However, the levels of these cytokines, except cholesterol, were significantly lower in the sericin group than in the KOA group. The KOA group exhibited significantly lower serum TAS and IL-10 levels than the C group (P < 0.05). In the sericin group, there was a statistically significant increase (P < 0.05).

CONCLUSION

Sericin shows promising potential for reducing inflammation, oxidative stress, and lipid metabolism in experimental models of KOA in rats. However, further clinical research is necessary to validate the potential of sericin as a therapeutic agent for treating KOA. Key Points • Sericin can reduce knee osteoarthritis (KOA) symptoms in an experimental rat model. • In particular, in the serum of an experimental KOA rat model, sericin specifically reduces the levels of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β), and increases the levels of anti-inflammatory cytokines, such as IL-10. • Sericin reduced lipid metabolism via the sterol regulatory protein (SREBP)-1C and SREBP-2 pathways and oxidative stress in the serum of the experimental KOA rat model. • The intra-articular administration of sericin has been shown to significantly reduce lipid metabolism, oxidative stress, and inflammation, as supported by biochemical analysis. These findings suggest its promising potential as an alternative treatment option for KOA.

The association between lipid biomarkers and osteoarthritis based on the National Health and Nutrition Examination Survey and Mendelian randomization study

To explore the association between lipid markers and osteoarthritis (OA). First, the National Health and Nutrition Examination Survey (NHANES) database was used to screen participants with lipid markers, OA and relevant covariates, and logistic regression was used to analyze the association between lipid markers and OA; Then, under the theoretical framework of Mendelian randomization (MR), two-sample MR was performed using GWAS data of lipid markers and OA to explore the causal association between the two, which was analyzed by inverse variance weighting (IVW) method. Heterogeneity test, sensitivity analysis and pleiotropy analysis were also performed. The NHANES database screened a total of 3706 participants, of whom 836 had OA and 2870 did not have OA. When lipid markers were used as continuous variables, multivariate logistic results showed an association between HDL, LDL and OA (HDL, OR (95%):1.01 (1.00, 1.01); LDL, OR (95%):1.00 (0.99, 1.00)). When lipid markers were used as categorical variables, multivariate logistic results showed the fourth quartile result of 0.713 (0.513, 0.992) for LDL relative to the first quartile. In MR study, the results of the IVW method for TG, TL, HDL and LDL showed OR (95% CI) of 1.06 (0.97-1.16), 0.95 (0.85-1.06), 0.94 (0.86-1.02) and 0.89 (0.80-0.998) with P-values of 0.21, 0.37. 013, 0.046. The heterogeneity tests and multiplicity analyses showed P-values greater than 0.05, and sensitivity analyses showed no abnormal single nucleotide polymorphisms. Through NHANES database and MR analyses, LDL was found to be a protective factor for OA, while HDL still needs further study. Our results provide new biomarkers for preventive and therapeutic strategies for OA.

A Cross-sectional Study to Estimate the Proportion and Ascertain Risk Factors for Osteoarthritis Knee among Women above 45 Years of Age Attending a Tertiary Care Hospital

Background

With aging, women face various health issues, the most common of which are musculoskeletal disorders. Osteoarthritis accounts for 15% of all musculoskeletal disorders in patients above the age of 45 years but receives little attention. This study aims to estimate the proportion of women above 45 years suffering from Osteoarthritis (OA) knee and to ascertain its risk determinants.

Materials and Methods

A cross-sectional study was conducted among 380 women above 45 years of age attending the Orthopedic outpatient department of a tertiary care hospital over a period of 18 months. American College of Rheumatology clinicoradiological criteria were used for the diagnosis of OA knee. A predesigned case record form was used to collect information on sociodemographic profile and other risk factors.

Results

Data were analyzed using SPSS version 16.0. Our study found the overall proportion of OA knee to be 69.2%. The Chi-square test was used to find the association of various factors with OA knee. On logistic regression, diabetes mellitus, hypertension, menopause, and increased body mass index were found to be significant for OA Knee.

Conclusion

The study concludes the possibility of prevention of disabilities by early screening for OA Knee in those with risk factors as a part of wellness clinics.

Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review

PURPOSE OF REVIEW

Metabolic syndrome (MetS), also called the 'deadly quartet' comprising obesity, diabetes, dyslipidemia, and hypertension, has been ascertained to have a causal role in the pathogenesis of osteoarthritis (OA). This review is aimed at discussing the current knowledge on the contribution of metabolic syndrome and its various components to OA pathogenesis and progression.

RECENT FINDINGS

Lately, an increased association identified between the various components of metabolic syndrome (obesity, diabetes, dyslipidemia, and hypertension) with OA has led to the identification of the 'metabolic phenotype' of OA. These metabolic perturbations alongside low-grade systemic inflammation have been identified to inflict detrimental effects upon multiple tissues of the joint including cartilage, bone, and synovium leading to complete joint failure in OA. Recent epidemiological and clinical findings affirm that adipokines significantly contribute to inflammation, tissue degradation, and OA pathogenesis mediated through multiple signaling pathways. OA is no longer perceived as just a 'wear and tear' disease and the involvement of the metabolic components in OA pathogenesis adds up to the complexity of the disease. Given the global surge in obesity and its allied metabolic perturbations, this review aims to throw light on the current knowledge on the pathophysiology of MetS-associated OA and the need to address MetS in the context of metabolic OA management. Better regulation of the constituent factors of MetS could be profitable in preventing MetS-associated OA. The identification of key roles for several metabolic regulators in OA pathogenesis has also opened up newer avenues in the recognition and development of novel therapeutic agents.

Metabolic syndrome and the likelihood of knee pain and functional disability: evidence from a large middle eastern population-based study

OBJECTIVES

Metabolic Syndrome (MetS) has been associated with knee osteoarthritis (KOA) in animal studies, but epidemiologic evidence of the association remains controversial. We investigated the association between MetS and knee pain and functional disability, the hallmarks of KOA, in a Middle Eastern population with high reported MetS rates.

METHODS

A population-based study of adult individuals was conducted between 01/2016 and 03/2019. Data collected included age, sex, blood pressure, body mass index (BMI), waist circumference (WC), and comprehensive metabolic panel blood tests. Knee symptoms were assessed using The Western Ontario and McMaster Arthritis index (WOMAC) The Adult Treatment Panel III criteria was applied to determine if participants had MetS. Multivariable regression was used to determine the association of MetS, and its components, with the WOMAC total and subscale scores.

RESULTS

Of 6,000 participants enrolled, 15.5% had MetS. The multivariate regression demonstrated that participants with MetS had significantly higher WOMAC total and subscale scores after adjusting for demographic variables; however, these associations were not significant after adjusting for BMI. Multivariate regression examining the association between MetS components and the WOMAC scores showed sex-based significant differences with WOMAC scores; however, the differences were not larger than the minimally clinical important differences.

CONCLUSIONS

This study demonstrated that after adjustment for BMI, neither MetS nor its individual parameters were associated with worse knee symptoms. As such, the association between MetS and worse knee symptoms requires further study.

Healthy beverage index could decrease odds of metabolic syndrome: A cross-sectional study

Some studies indicated that sugar-sweetened beverages (SSBs) were related to MetS risk, and others found no relationship between MetS and SSBs. Therefore, the present study aimed to investigate the relationship between healthy beverage index (HBI) and MetS in Iranian adults. This cross-sectional study was performed on baseline data FASA cohort. Out of 10,127 participants in the FASA cohort study, 8838 participants were included in this study. The National Cholesterol Education Program's Adult Treatment Panel (ATP) III was used for MetS definition. The HBI was calculated by a 125-item food frequency questionnaire with standard criteria. The association between HBI and MetS and its components was evaluated by univariate regression. Multivariate regression with the backward method was used for adjusting confounders. p < .05 was considered as statistically significant. Compared to the first quartile, it was observed that HBI in the last quartile was significantly related to lower odds of MetS in the multivariate analysis (odds ratio [OR] = 0.72; 95% confidence interval [CI]: 0.60-0.87, p < .001). Also, we observed a significant association between the last quartile of HBI with lower odds of high waist circumference (WC) (OR = 0.55; 95% CI: 0.45-0.67, p < .002). Our findings showed that the higher HBI score reduced MetS odds and WC. Therefore, to reduce the odds of MetS, a healthy pattern of beverage consumption, including drinking water, low-fat milk, unsweetened tea, and coffee, and reducing the consumption of SSB are recommended. More studies are needed to confirm the findings.

Intensive cholesterol-lowering treatment reduces synovial inflammation during early collagenase-induced osteoarthritis, but not pathology at end-stage disease in female dyslipidemic E3L.CETP mice

INTRODUCTION

The association between metabolic syndrome (MetS) and osteoarthritis (OA) development has become increasingly recognized. In this context, the exact role of cholesterol and cholesterol-lowering therapies in OA development has remained elusive. Recently, we did not observe beneficial effects of intensive cholesterol-lowering treatments on spontaneous OA development in E3L.CETP mice. We postulated that in the presence of local inflammation caused by a joint lesion, cholesterol-lowering therapies may ameliorate OA pathology.

MATERIALS AND METHODS

Female ApoE3∗Leiden.CETP mice were fed a cholesterol-supplemented Western type diet. After 3 weeks, half of the mice received intensive cholesterol-lowering treatment consisting of atorvastatin and the anti-PCSK9 antibody alirocumab. Three weeks after the start of the treatment, OA was induced via intra-articular injections of collagenase. Serum levels of cholesterol and triglycerides were monitored throughout the study. Knee joints were analyzed for synovial inflammation, cartilage degeneration, subchondral bone sclerosis and ectopic bone formation using histology. Inflammatory cytokines were determined in serum and synovial washouts.

RESULTS

Cholesterol-lowering treatment strongly reduced serum cholesterol and triglyceride levels. Mice receiving cholesterol-lowering treatment showed a significant reduction in synovial inflammation (P = 0.008, WTD: 95% CI: 1.4- 2.3; WTD + AA: 95% CI: 0.8- 1.5) and synovial lining thickness (WTD: 95% CI: 3.0-4.6, WTD + AA: 95% CI: 2.1-3.2) during early-stage collagenase-induced OA. Serum levels of S100A8/A9, MCP-1 and KC were significantly reduced after cholesterol-lowering treatment (P = 0.0005, 95% CI: -46.0 to -12.0; P = 2.8 × 10^-10, 95% CI: -398.3 to -152.1; P = 2.1 × 10^-9, -66.8 to -30.4, respectively). However, this reduction did not reduce OA pathology, determined by ectopic bone formation, subchondral bone sclerosis and cartilage damage at end-stage disease.

CONCLUSION

This study shows that intensive cholesterol-lowering treatment reduces joint inflammation after induction of collagenase-induced OA, but this did not reduce end stage pathology in female mice.

IL-1β inhibition combined with cholesterol-lowering therapies decreases synovial lining thickness and spontaneous cartilage degeneration in a humanized dyslipidemia mouse model

INTRODUCTION

Both systemic inflammation and dyslipidemia contribute to osteoarthritis (OA) development and have been suggested as a possible link between metabolic disease and OA development. Recently, the CANTOS trial showed a reduction in knee and hip replacements after inhibition of IL-1β in patients with a history of cardiovascular disease and high inflammatory risk. In this light, we investigated whether inhibition of IL-1β combined with cholesterol-lowering therapies can reduce OA development in dyslipidemic APOE∗3Leiden mice under pro-inflammatory dietary conditions.

MATERIALS AND METHODS

Female ApoE3∗Leiden mice were fed a cholesterol-supplemented Western-Type diet (WTD) for 38 weeks. After 14 weeks, cholesterol-lowering and anti-inflammatory treatments were started. Treatments included atorvastatin alone or with an anti-IL1β antibody, and atorvastatin combined with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor alirocumab without or with the anti-IL1β antibody. Knee joints were analyzed for cartilage degradation, synovial inflammation and ectopic bone formation using histology at end point.

RESULTS

Cholesterol-lowering treatment successfully decreased systemic inflammation in dyslipidemic mice, which was not further affected by inhibition of IL-1β. Synovial thickening and cartilage degeneration were significantly decreased in mice that received cholesterol-lowering treatment combined with inhibition of IL-1β (P < 0.01, P < 0.05, respectively) compared to mice fed a WTD alone. Ectopic bone formation was comparable between all groups.

CONCLUSION

These results indicate that inhibition of IL-1β combined with cholesterol-lowering therapy diminishes synovial thickening and cartilage degeneration in mice and may imply that this combination therapy could be beneficial in patients with metabolic inflammation.

COVID-19 Induces Body Composition and Metabolic Alterations

Background Individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are highly susceptible to disease-related metabolic dysregulation given the hyperinflammatory immune response of coronavirus disease 2019 (COVID-19). These changes are remarkably involved in multiple steps in adipogenesis and lipolysis. This study aimed to elaborate on the significant relations of COVID-19 infection with body fat distribution, changes in serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before and after the infection. Methods In this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Validated food frequency (FFQ) and physical activity questionnaires were completed. Body composition was assessed in this investigation. On the second visit, those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. All measurements were re-measured in the second visit. Results In a total of 441 patients, the mean age was 38.82±4.63 years. There were 224 (50.79%) male subjects, and 217 (49.20%) were females. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups. When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were. Serum insulin and HOMA-IR levels increased significantly after infection compared to the primary measurements. Conclusion Individuals with COVID-19 infection may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes such as muscle loss and fat accommodation.

Metformin mitigates cholesterol accumulation via the AMPK/SIRT1 pathway to protect osteoarthritis chondrocytes

In this study, we aim to investigate the effect of metformin on cholesterol synthesis and efflux-related genes in chondrocytes during osteoarthritis (OA) and explore the underlying mechanisms. Primary chondrocytes were harvested from Wistar rat cartilage and divided into control and treatment groups. Chondrocytes in the treatment group were treated with interleukin-1β (IL-1β) mimicking the inflammatory environment of osteoarthritis. Subsequently, RT-qPCR, Western blotting, immunofluorescence staining, and Cell Counting Kit-8 (CCK-8) were conducted. Significant reductions in phosphorylated AMP-activated protein kinase (p-AMPK) and silent information regulator 1 (SIRT1) protein expression were observed in both human OA chondrocytes and cultured primary murine chondrocytes treated with IL-1β, while AMP-activated protein kinase (AMPK) was not inhibited. Moreover, in the presence of IL-1β, metformin significantly increased the expression of p-AMPK and SIRT1 at the protein and mRNA level. Meanwhile, metformin could reverse IL-1β-induced cartilage extracellular matrix degradation in chondrocytes from the rat model of OA (treated by IL-β) by activating the AMPK/SIRT1 pathway. Moreover, metformin activated AMPK and SIRT1, mediated by the activation of SREBP-2 and HMGCR in OA chondrocytes. Inhibiting AMPK/SIRT1 activity by its specific inhibitor could suppress IL-1β-induced expression of LXRα, ABCA1 and ApoA1 and cholesterol efflux. Thus, metformin inhibits cholesterol synthesis and promotes cholesterol efflux by activating the AMPK/SIRT1 pathway in OA chondrocytes. This study improves our understanding of the effect of metformin on cholesterol accumulation in OA chondrocytes.

Association Between Metabolic Syndrome, Its Components, and Knee Osteoarthritis in Premenopausal and Menopausal Women: A Pilot Study

Objective: This pilot study aimed to determine the correlation of metabolic syndrome (MetS), its components, and increased LDL (low-density lipoprotein) and total cholesterol levels with osteoarthritis (OA). In addition, our goal was to establish the association between MetS and the degree of handicap measured by the Lequesne index of functionality and severity of knee osteoarthritis.

Materials and methods: The pilot study included 25 subjects with knee OA and 19 subjects without knee OA. All subjects were menopausal or premenopausal women. MetS was diagnosed according to the National Cholesterol Education Program, Adult Treatment Panel III. OA was diagnosed if Kellgren-Lawrence ≥ 2.

Results: MetS was detected in 80% of subjects with OA. In the non-OA group, MetS was detected in 26% of subjects. The difference in MetS prevalence between the two groups was significant (p=0.000). The presence of each MetS component was significant in the OA group, except for central obesity, which presence was marginally significant (p=0.054). Prevalence of increased total (p=0.019) and LDL cholesterol (p=0.000) was also significant in the OA group. A significant difference between OA and the non-OA group was detected in the prevalence of all five MetS components (p=0.016). In the OA group, the Lequesne index of functionality and severity of knee osteoarthritis was not significantly altered between subjects with and without MetS.

Conclusion: Metabolic syndrome, its components, increased LDL, and total cholesterol are correlated with osteoarthritis in premenopausal and menopausal women. MetS is not correlated with the degree of handicap in the knee joint measured by the Lequesne index.

Oral contraceptive pill and metabolic syndrome: Fasa Persian Cohort Study (Descriptive study)

BACKGROUND AND AIMS

The contraceptive use is 56% and prevalence of metabolic syndrome (MetS) is 30% in Iran. The aim of this study investigates relationship between oral contraceptive pills (OCP) use and MetS in women in the cohort population of Fasa city.

METHODS

In a cross-sectional study, 5489 women aged 35-70 years were studied for 5 years in the Sheshdeh area in 2016. MetS were calculated using adult treatment panel III (ATP III) and international diabetes federation (IDF) methods. The odds ratio (OR) with a 95% confidence interval (CI) was reported. Linear regression was used to eliminate the confounding effect.

RESULTS

The OR of developing MetS in the OCP recipients was estimated as higher than the non-recipients. The OR of developing MetS using IDF criteria in OCP recipients was (OR = 0.896,95% CI:0.800-1.004). that increased to (OR = 1.230,95% CI:1.084-1.395) after adjusting for confounding variables. Also, the odds ratio using ATP (III) criteria was (OR = 0.900,95% CI:0.804-1.009). that increased to (OR = 1.245,95% CI:1.098-1.413) after adjusting for confounding variables. Also, the OR of developing MetS in OCP recipients decreased with increasing the number of MetS components from 1.199 to 0.812,95% CI:0.771-1.864,0.467-1.413, but after adjustment, increased from 1.151 to 1.747,95% CI:0.733-1.805,0.815-3.746.

CONCLUSION

The results of the present study showed that the OR of developing MetS in OCP recipients using both IDF and ATP (III) methods was higher after adjusting by confounder effects so it is recommended monitoring by physicians.

Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies

Objective

Literature examining the relationship between elevated blood pressure and osteoarthritis (OA) has yielded conflicting results. This study aimed to systematically review the relationship between hypertension and OA in both load-bearing and non-load-bearing joints.

Methods

A systematic literature search was performed on Embase, Emcare, MEDLINE and Ovid Nursing Database. The associations between hypertension and OA development in knees, hips and hands were analysed by calculating the odds ratio (OR).

Results

A total of 26 studies with 97,960 participants were included. The overall odds of having OA significantly increased in the people with hypertension compared to the normotensive ones (OR ​= ​1.60, 95%CI ​= ​1.33, 1.94). The association of hypertension with OA was detected in knee (OR ​= ​1.62, 95%CI ​= ​1.32, 1.98), not in hand (OR ​= ​1.19, 95%CI ​= ​0.92, 1.53). Moreover, there existed a stronger association of hypertension with radiographic knee OA (OR ​= ​1.89, 95%CI ​= ​1.40, 2.54) than symptomatic knee OA (OR ​= ​1.39, 95%CI ​= ​1.17, 1.65). The association between hypertension and radiographic knee OA remained statistically significant for the studies that adjusted for body mass index (BMI) (OR ​= ​1.42, 95%CI ​= ​1.13, 1.78), and was particularly strong in women (OR ​= ​2.27, 95%CI ​= ​1.17, 4.39).

Conclusion

A BMI-independent association between hypertension and radiographic knee OA existed with potential sex variation, which warrants further investigations into the underlying genetic, hormonal and environmental factors.

The translational potential of this article: Blood pressure has been reported to link with OA for years ago, however, its contribution to OA is still unclear and conflicted in different reports. This review indicated an intimate relationship between hypertension and structural damages of knee OA, rather than simply chronic joint pain, especially in women. This finding not only provides stronger support for further investigations into the causal risk factor, i.e. hypertension, of OA from tissue level to molecular level, but also putting forward a novel thinking in OA pathogenesis and its therapy strategies.

Orthopedic translation

This study further strengthen the association between hypertension and radiographic knee OA. It points in a vascular aetiology hypothesis of OA. It might open up a new avenue for repositioning anti-hypertensive medications for osteoarthritis treatment.

Metabolic Syndrome Predisposes to Osteoarthritis: Lessons from Model System

OBJECTIVE

The present study aims to assess for temporal changes in tibial subchondral bone and cartilage in WNIN/Gr-Ob rats (portraying obesity, insulin resistance, dyslipidemia, impaired glucose tolerance, hypertension) in comparison with Wistar controls (WNIN) using anthropometry, micro-computed tomography (micro-CT), scanning electron microscopy (SEM), histopathology, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence.

DESIGN

Body weight, abdominal circumference, body mass index (BMI), lean/fat mass, serum tumor necrosis factor (TNF)-α levels were measured (ELISA), followed by ultrastructural analysis of tibial subchondral bone (micro-CT) and cartilage architecture (histopathology and SEM) in WNIN/Gr-Ob and WNIN rats with age (3, 6 and 9 months). Additionally, primary cultures of articular chondrocytes isolated from 6-month-old WNIN/Gr-Ob and WNIN rats were assessed for matrix metalloproteinase (MMP)-13 and Collagen type II (COL2A1) by immunofluorescence.

RESULTS

WNIN/Gr-Ob rats exhibited frank obesity with increased BMI, lean and fat mass vis-à-vis significantly higher levels of serum TNF-α (6>9>3 months) as compared with the controls. With an increase in BMI, WNIN/Gr-Ob rats presented with tibial cartilage fibrillation, erosion, osteophyte formation (6 months) and subchondral bone cyst (9 months) confirmed by histology and SEM. An increase in subchondral trabecular bone volume (sclerosis with decreased plate porosity) was observed in all ages in WNIN/Gr-Ob rats compared to their Control. Gaining insights, primary cultures of articular chondrocytes complemented with altered cellular expressions of COL2A1 and MMP-13 from WNIN/Gr-Ob rats, indicating osteoarthritis (OA) progression.

CONCLUSION

Multiple metabolic perturbations featured in WNIN/Gr-Ob rats were effective to induce spontaneous OA-like degenerative changes affecting knee joints akin to human OA.

Accelerated osteoarthritis in women with polycystic ovary syndrome: a prospective nationwide registry-based cohort study

BACKGROUND

Osteoarthritis (OA) is the most common form of arthritis with multiple risk factors implicated including female sex and obesity. Metabolic dysregulation associated with obesity leading to metabolic syndrome is a proposed component of that association. Polycystic ovary syndrome (PCOS) commonly affects women of reproductive age and these women are at higher risk of developing metabolic syndrome and thus likely to represent a high-risk group for early OA development. There are no published studies exploring the epidemiology of knee, hip and hand OA in women diagnosed with PCOS.

STUDY AIM

To assess the prevalence and incidence of knee, hip and hand osteoarthritis (OA) in women with polycystic ovary syndrome (PCOS) when compared with age-matched controls.

METHODS

Prospective Danish national registry-based cohort study. The prevalence of OA in 2015 and incidence rates of OA over 11.1 years were calculated and compared in more than 75,000 Danish women with either a documented diagnosis of PCOS ± hirsutism (during the period of 1995 to 2012) or age-matched females without those diagnoses randomly drawn from the same population register.

RESULTS

In 2015, the prevalence of hospital treated knee, hip and hand OA was 5.2% in women with PCOS diagnosis. It was 73% higher than that seen in age-matched controls. Significantly higher incidence rates were observed in the PCOS cohort compared with the age-matched controls during the follow-up period (up to 20 years), with the following hazard ratios (HR): 1.9 (95% CI 1.7 to 2.1) for knee, 1.8 (95% CI 1.3-2.4) for hand and 1.3 (95% CI 1.1 to 1.6) for hip OA. After excluding women with obesity, similar associations were observed for knee and hand OA. However, risk of developing hip OA was no longer significant.

CONCLUSIONS

In this large prospective study, women with PCOS diagnosis had higher prevalence and accelerated onset of OA of both weight and non-weight bearing joints, when compared with age-matched controls. Further studies are needed to understand the relative effect of metabolic and hormonal changes linked with PCOS and their role in promoting development of OA.

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study)

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P > 0.05). The overall mean of DII was - 0.89 ± 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females.

An update on the association between metabolic syndrome and osteoarthritis and on the potential role of leptin in osteoarthritis

Metabolic syndrome (MetS) has been associated with osteoarthritis (OA). Leptin, which is one of the markers of MetS, has been associated with OA pathophysiology. This study aimed to provide an update on the association between MetS and OA and on the potential role of leptin in OA. In this review, we summarized the current knowledge of the association between MetS and OA and updated the evidence on the potential role of leptin in OA. Clinical studies have investigated the epidemiologic association between MetS or its components and OA. Results suggested strong epidemiologic associations between MetS and OA, especially in the Asian population. Animal studies also indicated that metabolic dysregulation may lead to OA pathogenesis. The systemic role of MetS in OA pathophysiology is associated with obesity-related inflammation, the beneficial role of n-3 polyunsaturated fatty acids and deleterious role of cholesterol, physical inactivity, hypertension-induced subchondral ischemia, dyslipidemia-induced ectopic lipid deposition in chondrocytes, hyperglycemia-induced local effects of oxidative stress and advanced glycation end-products, low-grade systemic inflammation, and obesity-related adipokines by inducing the expression of proinflammtory factors. Leptin levels in serum/plasma and synovial fluid were associated with joint pain, radiographic progression, bone formation biomarkers, cartilage volume, knee OA incidence, and total joint arthroplasty in OA patients. Elevated leptin expression and increased effect of leptin on infrapatellar fat pad, synovium, articular cartilage, and bone were also involved in the pathogenesis of OA. Current knowledge indicates a convincing epidemiologic association between MetS and OA, especially in the Asian population. Animal studies have also shown that metabolic dysregulation may lead to OA pathogenesis. Accumulating evidence suggests that leptin may play a potential role in OA pathogenesis. Therefore, leptin and its receptor may be an emerging target for intervention in metabolic-associated OA.

The role of adipose tissue secretion in the creation and pain level in osteoarthritis

Objectives. With increasing evidence regarding the metabolic basis of osteoarthritis (OA), we studied the relationship between adipose tissue and OA.

Methods. This study is part of an OA registry in the eastern part of Fars Province, Iran. Overall, 150 patients with OA and 300 sex matched individuals were selected as a control group. They were compared regarding adipokine concentration (leptin, adiponectin, resistin and visfatin), anthropo-metric indices, the Western Ontario and McMaster universities arthritis index score (WOMAC).

Results. All adipokine levels were higher among OA patients (p<0.001). After adjusting for age, sex, and body mass index (BMI), adipokines showed a significant and positive association with OA (B: 14.12, B: 9.92, B: 24.71 and B: 12.29 for leptin, adiponectin, visfatin, and resistin, respectively; p<0.001). Except the adiponectin that had a negative relationship with BMI in the OA group (r=–0.570, p<0.001), other adipokines had positive relationships with BMI (r=0.781, p<0.001; r=0.530, p<0.001; r=0.549, p<0.001 for leptin, visfatin, and resistin, respectively). Only leptin and adiponectin levels were correlated with pain (B: 0.045, –0.079 and p<0.05).

Conclusion. The present study shows that aside to the well-known role of mechanical stress in OA pathogenesis (weight load), leptin, adiponectin, visfatin, and resistin, which represent the adi-pose tissue independent on the weight, may play a chemical role in OA pathogenesis. In addition, leptin and adiponectin may be involved in the pain levels among patients with OA.

Bidirectional association between metabolic syndrome and osteoarthritis: a meta-analysis of observational studies

BACKGROUND

Emerging observational studies suggest an association between metabolic syndrome (MetS) and osteoarthritis (OA). This meta-analysis was conducted to examine whether or not there is a bidirectional relationship between MetS and OA.

METHODS

The PubMed and Embase databases were searched from their inception to October 2019. We selected studies according to predefined criteria. Random effects were selected to calculate two sets of pooled risk estimates: MetS predicting OA and OA predicting MetS.

RESULTS

A total of seven cross-sectional studies and four cohort studies met the criteria for MetS predicting the onset of OA. Another six cross-sectional studies and one cohort study met the criteria for OA predicting the onset of MetS. The pooled odds risk (OR) for OA incidences associated with baseline MetS was 1.45 (95% CI 1.27-1.66). The OR for MetS incidences associated with baseline OA was 1.90 (95% CI 1.11-3.27). In an overall analysis, we found that MetS was associated with prevalent OA in both cross-sectional studies (OR = 1.32, 95% CI 1.21-1.44) and cohort studies (OR = 1.76, 95% CI 1.29-2.42). No indication of heterogeneity was found in the cross-sectional studies (p = 0.395, I² = 4.8%), whereas substantial heterogeneity was detected in the cohort studies (p = 0.000, I² = 79.3%).

CONCLUSION

Meta-analysis indicated a bidirectional association between MetS and OA. We advise that patients with MetS should monitor their OA status early and carefully, and vice versa.

What Is the Evidence to Support the Association Between Metabolic Syndrome and Osteoarthritis? A Systematic Review

OBJECTIVE

There is conflicting evidence on the association between metabolic syndrome (MetS) with the risk of osteoarthritis (OA). We aimed to systematically summarize the empirical evidence and discuss challenges in research methodologies in addressing this question.

METHODS

We performed a systematic literature review based on PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews on published epidemiologic studies that examined the association between MetS and the risk of OA. We included cross-sectional studies, case-control studies, and cohort studies with appropriate covariate adjustments. We extracted information on prevalence, incidence, crude and adjusted effect estimates, and the 95% confidence intervals from the articles, or this information was provided by the authors. We listed the main methodologic issues existing in current literature and provided recommendations for future research on this topic.

RESULTS

We identified 7 eligible studies on knee OA, 3 on hip OA, and 3 on hand OA. In studies that adjusted for body mass index or weight, MetS was not significantly associated with the risk of knee OA. No significant associations were reported for hip OA. For hand OA, the data were sparse and insufficient to reach a conclusion. Studies were mostly cross-sectional, exposure included only 1 time measurement, few studies had incident outcomes, and covariate adjustment was often insufficient.

CONCLUSION

Our review was unable to reach a definitive conclusion due to insufficient data, although the data suggest that knee and hip OA are not associated with MetS. Future longitudinal studies with incident OA cases, repeated measurement of MetS, and appropriate covariate adjustment are needed.