Kreutzinger Virginie, Ziegeler Katharina, Joseph Gabby B, Lynch John A, Akkaya Zehra, Lane Nancy E, McCulloch Charles E, Nevitt Michael, Link Thomas M
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Osteoarthr Cartil Open. 2025 Jul 17;7(3):100653. doi: 10.1016/j.ocarto.2025.100653. eCollection 2025 Sep.
Weight loss can modify the progression of osteoarthritis (OA), and this may, in part, be achieved by decreased synovitis, a known accelerator of cartilage degeneration. The purpose of this study was to investigate whether change in synovitis mediates the beneficial effect of weight loss on longitudinal cartilage outcomes.
We analyzed right knees with baseline Kellgren & Lawrence grades 1-3 of 1153 obese and overweight participants of the Osteoarthritis Initiative (OAI) cohort with Whole Organ MRI Scores (WORMS) and semi-quantitative assessment of effusion synovitis and synovial proliferation scores form 3T MRIs at baseline and 48 months. There were 295 participants with weight-loss >5 % and 858 stable weight controls. Ordered logistic regression was used to assess the association of weight-loss status with concurrent changes in synovitis as well as cartilage WORMS scores; models were adjusted for age, gender, race, presence of radiographic OA, and abdominal circumference at baseline. A mediation analysis was used to determine whether change in overall cartilage degeneration was mediated by change in synovitis scores.
Individuals who lost weight had significantly lower odds for a higher grade on the scale assessing change in overall synovitis (OR 0.72; 95%CI 0.54, 0.95; p = 0.018). Mediation analysis showed that slowing synovitis during weight loss had a small mediating effect on longitudinal cartilage outcomes.
Decreased cartilage degeneration during weight loss was partially mediated by concurrent deceleration in synovitis, showing that decreasing systemic inflammation during weight-loss may not be mirrored in imaging markers of joint inflammation.
体重减轻可改变骨关节炎（OA）的病情进展，部分原因可能是滑膜炎减轻，而滑膜炎是已知的软骨退变加速因素。本研究旨在探讨滑膜炎的变化是否介导了体重减轻对软骨纵向结局的有益作用。
我们分析了骨关节炎倡议（OAI）队列中1153名肥胖和超重参与者的右膝，这些参与者基线时Kellgren&Lawrence分级为1-3级，采用全器官MRI评分（WORMS）以及对基线和48个月时3T MRI的积液滑膜炎和滑膜增生评分进行半定量评估。有295名体重减轻>5%的参与者和858名体重稳定的对照者。采用有序逻辑回归评估体重减轻状态与滑膜炎同时发生的变化以及软骨WORMS评分之间的关联；模型针对年龄、性别、种族、影像学OA的存在情况以及基线时的腹围进行了调整。采用中介分析来确定总体软骨退变的变化是否由滑膜炎评分的变化介导。
体重减轻者在评估总体滑膜炎变化的量表上处于较高等级的几率显著较低（OR 0.72；95%CI 0.54,0.95；p = 0.018）。中介分析表明减肥期间滑膜炎的减缓对软骨纵向结局有较小的中介作用。
减肥期间软骨退变的减少部分由滑膜炎同时减缓介导，这表明减肥期间全身炎症的减轻可能不会反映在关节炎症的影像学标志物上。
