Tuesday, 2 February 2016

SPHPM researchers consider the link between osteoarthritis and obesity

Professor Flavia Cicuttini was featured yesterday in the Medical Journal of Australia (MJA) in an editorial challenging the long-held belief that osteoarthritis is a wear-and-tear disease of older age, with new findings suggesting that the effect of obesity on the joint may be via metabolically driven inflammation.

Professor Cicuttini is a rheumatologist and heads the Musculoskeletal Unit at SPHPM. She said the research highlights the importance of preventing obesity in early life to avoid early joint damage, as it sets up a vicious cycle of further joint damage through both inflammation and loading.

“It is commonly believed that obesity affects joints through loading. However, there must be additional mechanisms since, for decades, obesity has been known to be a strong risk factor for hand osteoarthritis. Given that we do not walk on our hands, an effect of obesity through loading of the joints cannot be the whole explanation,” Professor Cicuttini said.

Over the past decade, she said, magnetic resonance imaging (MRI) has made it possible to examine the effect of obesity on joints, and to untangle the issue of whether obesity causes osteoarthritis or whether the pain of osteoarthritis causes obesity through modification of lifestyle behaviours and consequent weight gain.

Obesity continues to be a key risk factor for osteoarthritis across a wide range of joints including hands, back, hip and knees.

What the research has revealed however is that obesity is a causative factor in the development of osteoarthritis, with increased weight being associated with early articular cartilage damage, well before symptoms develop.

“Body fat is in fact, not an inert structure but rather a highly metabolically active tissue that produces inflammatory molecules, including cytokines and adipokines that have been shown to damage joints through cartilage loss,” Professor Cicuttini said.

The implications of these findings for weight-bearing joints is particularly bad news she said.

“Because obesity affects joints through both mechanical loading and metabolically driven inflammation, the effects are synergistic; the joint that is being loaded, rather than being healthy, is also subjected to low-grade inflammation, a double ‘hit’,” she said.

Professor Cicuttini said that novel therapies aimed at targeting inflammatory pathway warrant further investigation, due to the growing obesity crisis, and its associated burden of osteoarthritis.

You can listen to Professor Cicuttini talking about the research here in a MJA special podcast, or watch her MJA YouTube video below. 

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