Background Studies of mental health in patients with osteoarthritis (OA) are topical at the present time. This applies especially to OA patients with such comorbidity as obesity, metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Psychological features, quality of life (QoL) and depression degree also can be linked with immunopathogenesis of OA with obesity, MS, T2DM.
Objectives To explore the mental health in knee OA patients with obesity, MS, T2DM and to estimate association between psychological and immunological features.
Methods Patients (n=128) with bilateral knee OA according to ACR criteria were divided into four groups. Group 1 (n=17) had obesity, group 2 (n=17) had MS, group 3 (n=56) had T2DM and group 4 (n=38) had only knee OA without comorbidity. All patients were comparable by age, sex and duration of OA. We assessed serum cytokine levels (IL-1b, IL-6, IL-10, IL-18), NO and adipokines (adiponectin, leptin) using ELISA. The parameters of QoL, mental health and depression degree were measured by short form 36 (SF-36), Knee injury and Osteoarthritis Outcome Score – (KOOS) and with patient health questionnaire-9 (PHQ-9). We also studied coping strategies to overcome pain by Coping Strategy Questionnaire (CSQ). U-Mann-Whitney test was applied to detect differences between groups. Correlation was assessed using Spearman correlation coefficient (rs).
Results During comparative analysis, we found many statistically significant differences in such indexes and questionnaires as SF-36, KOOS, PHQ-9, CSQ between groups knee OA patients with comorbidity and group knee OA patients without concomitant diseases. Patients with OA and obesity were characterized by low values of mental health (SF-MH) (median (Me) 52; interquartile range (IQR) 38–64; p=0.01). Patients from group 2 (MS) and 3 (T2DM) had significant impairment of QoL parameters, mental health values. Patients of these groups also had the higher degree of depression and built coping strategies to overcome pain of OA worse than patients of OA group. Differences in serum cytokine levels were found in patients with OA and T2DM (IL-6 p=0.0018; IL-18 p=0.0006; NO p<0.001). Significant high leptin level had OA patients with obesity (p=0.03) and OA patients with T2DM (p=0.0002). Correlation analysis identified the association between mental health and cytokines in OA patients with obesity and OA patients with T2DM. Some data are presented (Table).
Conclusions This study suggests that OA patients with obesity, MS and T2DM have special mental features which may be linked with immunological parameters. This data should be verified by larger studies and can be the part for an integrated program of treatment and rehabilitation of OA patients with comorbidity.
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Disclosure of Interest None declared