Department of Rheumatology, Nord Franche-Comté Hospital, Belfort, France.
Curr Rheumatol Rev. 2020;16(2):99-104. doi: 10.2174/1573397115666190625105759.
The close association between osteoarthritis (OA) and obesity is well established. Mechanisms linking obesity and OA involve multifactorial phenomena such as systemic factors (i.e. adipokines and pro-inflammatory cytokines), hormonal disturbances (hyperinsulinemia) and muscule changes (i.e. sarcopenia and lower muscular tone). The concomitant increasing prevalence of the two diseases have major health, social and economic consequences. However, to date no specific recommendation for the medical management of obese patients with OA have been published. Current recommendations only specify that obese patients must lose weight and practice regular physical activity in addition to the usual care. Weight loss improves not only OA symptoms but also metabolic abnormalities and cardiovascular risk factors commonly altered in subjects with obesity. OA symptoms' improvement has been shown to become clinically relevant from a weight loss > 5% of the body weight. In case of morbid obesity, bariatric surgery may be the only alternative for pain relief. After bariatric surgery, an appropriate calcium and vitamin D intake is recommended, since it has been shown that bariatric surgery was associated with a reduction in the bone mineral density and increased risk of fractures. An exercise program is essential for preserving healthy muscles during weight loss. Non-steroidal anti-inflammatory drugs and corticosteroids must be avoided, especially in obese patients with metabolic syndrome. In such patients symptomatic slow acting drugs for OA (i.e. glucosamine, chondroitin) and some anti-oxidant drugs (i.e. curcumin, ginger extracts, copper) may be helpful thanks to their excellent benefit/risk ratio and their mode of action which may have a positive impact on both OA and obesity-related metabolic disorders. Recent research focuses on the development of molecules aimed for promoting the production of heme oxygenase (HO-1). HO-1 decreases the production of oxygen free radicals and protects tissues from oxidative stress in the insulin resistance syndrome. Intra-articular (IA) injections of hyaluronic acid and corticosteroid have few adverse events. However, physicians must inform patients that IA treatments have a lower success rate in obese patients than in those with normal body mass index. Spa therapy contributes to relief pain, favour weight-loss and reduces metabolic abnormalities with a favourable risk/benefit balance.
骨关节炎（OA）和肥胖之间的密切关系是众所周知的。将肥胖与 OA 联系起来的机制涉及多种因素，如全身因素（即脂肪因子和促炎细胞因子）、激素紊乱（高胰岛素血症）和肌肉变化（即肌肉减少症和较低的肌肉张力）。这两种疾病的同时患病率不断上升，对健康、社会和经济都有重大影响。然而，迄今为止，尚未发表专门针对 OA 肥胖患者的医学管理建议。目前的建议仅规定肥胖患者除了常规护理外，还必须减肥并定期进行体育锻炼。减肥不仅可以改善 OA 症状，还可以改善肥胖患者常见的代谢异常和心血管危险因素。从体重减轻超过体重的 5%开始，OA 症状的改善就具有临床相关性。对于病态肥胖，减重手术可能是缓解疼痛的唯一选择。减重手术后，建议摄入适量的钙和维生素 D，因为研究表明，减重手术与骨密度降低和骨折风险增加有关。在减肥过程中，运动方案对于保持健康的肌肉至关重要。必须避免使用非甾体抗炎药和皮质类固醇，尤其是对于患有代谢综合征的肥胖患者。在这些患者中，针对 OA 的症状缓解的慢作用药物（即氨基葡萄糖、软骨素）和一些抗氧化药物（即姜黄素、姜提取物、铜）可能会有所帮助，因为它们具有出色的获益/风险比及其作用机制，可能对 OA 和肥胖相关的代谢紊乱都有积极影响。最近的研究重点是开发旨在促进血红素加氧酶（HO-1）产生的分子。HO-1 可减少氧自由基的产生，并在胰岛素抵抗综合征中保护组织免受氧化应激的影响。关节内（IA）注射透明质酸和皮质类固醇的不良反应较少。然而，医生必须告知患者，IA 治疗在肥胖患者中的成功率低于正常体重指数的患者。水疗有助于缓解疼痛、促进减肥和减轻代谢异常，具有良好的风险/效益平衡。
