Background Beyond the obesity-related osteoarthritis (OA), metabolic syndrome (MetS) related-OA has now been characterized as a subtype of OA due to the association between OA and MetS or its components. Some studies have suggested an association between OA and diabetes mellitus (DM).
Objectives Based on a systematic literature review (SLR), we aimed to investigate the prevalence of DM in OA patients, the prevalence of OA in DM patients and whether OA and DM are associated.
Methods A SLR was performed using 3 electronic databases (PubMed, Embase and Cochrane) in June 2013, updated in January 2014 and abstracts of international meetings (OARSI, EULAR and ACR 2011-13). We included cohort, case-control and cross-sectional studies assessing the number of patients with DM and/or OA. The prevalence of DM in OA patients and the prevalence of OA in diabetic patients were calculated. The results from trials assessing an association between diabetes and OA were pooled by meta-analysis using the RevMan-5 software and results were presented as unadjusted odds ratio (OR) and 95% confidence interval [95%CI]. In a sensitivity analysis, we removed studies with aberrant results and a random effect was performed in case of high heterogeneity between studies.
Results From the 292 published studies, 42 were included in the analysis: 21 cross-sectional, 11 cohort and 10 case-control studies. Sixteen, 5 and 21 involved exclusively OA patients, exclusively diabetes and general population, respectively. The median of STROBE quality scale was 69%. Among the 32 studies assessing the association between OA and DM, 20 displayed a significant association.
In 618,066 patients with OA (hand, knee, hip or other localisation), DM prevalence was 14.4±0.1% (mean ± SD). In 5,489 patients with DM, OA prevalence was 27.8±1.2% There was an increased risk of DM in OA population (OR =1.43 [1.21-1.68]) as well as of OA in DM population (OR=1.46 [1.06-2.02]) (Figure), despite heterogeneity between studies. Among the 12 studies which reported OR adjusted at least on BMI, 6 showed no association between DM and OA (smaller OR =0.56 [0.14-2.24]) while 6 identified DM as an independent risk factor of OA (higher OR =5.76 [1.06-31.21]).
Conclusions This SLR highlights a high frequency of OA in patients with DM and an association between both diseases. Limitations were the heterogeneity of studies due to OA and DM definitions and the inability to adjust to other OA risk factor like BMI. This study represents a further step toward the individualization of DM-related OA phenotype.
Disclosure of Interest None declared