Diabetes, obesity in osteoarthritis impact hip OA progression
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Comorbid chronic diseases common among patients with osteoarthritis, such as obesity, diabetes mellitus and cardiovascular disease, have a significant impact on the progression and persistence of hip osteoarthritis, according to data published in Arthritis Research & Therapy.
“In osteoarthritis research, we are always struggling with how best to define changes in disease status, such as whether to focus on symptoms or structural changes,” Amanda E. Nelson, MD, MSCR, RhMSUS, of the University of North Carolina at Chapel Hill, told Healio Rheumatology.
“The state transition modeling approach used in this paper allows simultaneous consideration of transitions based on both symptoms and structure — eg, development or resolution of hip pain, or development of new radiographic changes, or both — rather than one or the other in isolation, providing a more complete picture of the changes over time.”
“Additionally, we were able to include features that change over time, such as BMI and development of comorbidities, rather than only using static baseline values,” she added.
To analyze the link between obesity, diabetes mellitus and cardiovascular disease with hip OA status, Nelson and colleagues conducted a longitudinal study of data from the Johnston County Osteoarthritis Project. According to the researchers, this project is a community-based, prospective observational cohort of civilian, noninstitutionalized black and white men and women aged 45 years or older in Johnston County, North Carolina. Baseline data collection for the project occurred from 1991 to 1997 with 3,264 participants, with an enrichment cohort of 1,150 enrolled from 2003 to 2004 to replaces losses. The combined project cohort was 4,197 individuals.
For their study, Nelson and colleagues included data on 3,857 enrollees with available baseline, hip OA, vital status, hip injury, education, BMI, cardiovascular and diabetes mellitus information. Radiographic hip OA was defined as a Kellgren-Lawrence grade of less than2. The development of hip symptoms was characterized as self-reported hip pain, aching or stiffness on most days, while symptomatic hip OA was identified as the presence of radiographic hip OA and symptoms in the same hip.
The researchers used Markov multi-state models to estimate adjusted hazard ratios for links between obesity, cardiovascular disease and diabetes mellitus and hip OA states.
According to Nelson and colleagues, the frequencies of all three comorbidities increased significantly over time. Obesity was associated with incident hip symptoms, while cardiovascular disease and diabetes mellitus were linked to reduced symptom resolution. In addition, participants with more than one comorbidity demonstrated an increased likelihood of symptomatic hip OA, and decreased chances for symptom resolution.
However, when stratified by sex, the results indicate that the association between obesity and incident symptoms are present only in women. Among men with radiographic hip OA and diabetes mellitus, the researchers found an approximate 75% reduction in symptom resolution, compared with those without diabetes. In addition, when stratified by race, black participants with diabetes mellitus were more likely to develop symptomatic hip OA, compared with those without.
“These results confirm the negative impact of multiple comorbidities — ie, obesity, diabetes and cardiovascular disease — on the course of hip osteoarthritis over time,” Nelson said. “If confirmed in other studies, this may suggest a role for management of comorbidities as a strategy to mitigate hip osteoarthritis progression over time.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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