Exploring the links between obesity and musculoskeletal disorders
medwireNews: Presentations on the final day of the Annual European Congress of Rheumatology (EULAR) 2017 examined the relationship between diet, obesity, and rheumatologic diseases.
Pascal Richette (Hôpital Lariboisière, Paris, France) outlined the effects of weight loss among patients with psoriatic arthritis (PsA), knee osteoarthritis (OA), and gout.
“Obesity can increase the risk of developing PsA,” he said, describing the results of a study by Alexander Egeberg (Herlev and Gentofte Hospital, Hellerup, Denmark) and colleagues showing that participants had a lower risk for psoriasis after undergoing gastric bypass surgery compared with before, and those with PsA at baseline had a lower risk for progression to more severe disease after undergoing bypass surgery.
Richette noted that obesity has also been associated with a poor response to tumor necrosis factor (TNF) inhibitor treatment among patients with PsA, and that weight loss could improve response rates.
Overweight increases the risk for knee OA by twofold, while obesity increases the risk by 3.1- to 4.7-fold, continued Richette.
“Obesity is likely to influence knee OA through mechanical stress on knees and systemic stress,” he said, and described the results of the IDEA randomized trial showing that diet and exercise interventions reduce knee compressive force and interleukin (IL)-6 levels among overweight and obese people with OA. Participants receiving a diet and exercise intervention experienced a greater reduction in IL-6 levels than those doing exercise only, whereas patients assigned to follow a diet-only intervention had a greater reduction in knee compressive force than those assigned to use exercise only.
Furthermore, a study from his own group suggests that “massive weight loss” has an “impressive effect” on the symptoms of OA, added Richette. Indeed, pain measured on the Visual Analog Scale (VAS) decreased significantly from 50.0 points at baseline to 24.5 points at 6 months after gastric surgery among 44 patients with painful knee OA whose body mass index decreased from 50.7 to 40.4 kg/m2, and Western Ontario and McMaster Universities Osteoarthritis Index scores decreased from 187.3 to 94.1 points.
Shifting his focus to gout, Richette noted that “sixty percent of gout risk is attributable to excess weight,” and guidance from organizations including EULAR and the ACR recommends weight loss for patients with gout.
Sabrina Nielsen (The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark) then presented the results of a systematic review investigating the benefits and harms associated with weight loss in gout patients.
The team analyzed the results of 10 studies, in which participants lost between 3 and 30 kg of weight, and found that weight loss was associated with a change in serum uric acid (sUA) levels of between –168 and +30 µmol/L in eight studies investigating sUA levels. Furthermore, the proportion of patients achieving target sUA levels (<360 µmol/L) after weight loss ranged from 0 to 60%, and six out of eight studies that included gout attacks as an endpoint identified a beneficial effect of weight loss.
Weight loss occurred as a result of diet with or without physical activity, bariatric surgery, diuretics, metformin, or no intervention in the included studies, said Nielsen.
She noted that meta-analysis was not possible due to clinical heterogeneity, and cautioned that the included studies were of low or moderate quality.
Nevertheless, she concluded: “The available evidence indicates beneficial effects of weight loss for overweight gout patients regarding sUA, achieving sUA target, and gout attacks.”
By Claire Barnard
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