Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis
- Pascal Richette1,
- Christine Poitou2,3,4,5,
- Patrick Garnero6,7,
- Eric Vicaut8,
- Jean-Luc Bouillot9,
- Jean-Marc Lacorte10,
- Arnaud Basdevant2,3,4,5,
- Karine Clément2,3,4,5,
- Thomas Bardin1,
- Xavier Chevalier11
- 1Université Paris 7, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris Cedex, France
- 2Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Nutrition and Endocrinology Department, Paris, France
- 3Center of Research on Human Nutrition Ile de France, Paris, France
- 4INSERM, U872, Nutriomique Team 7, Paris, France
- 5Université Pierre et Marie Curie-Paris 6, Centre de Recherche des Cordeliers, UMRS 872, Paris, France
- 6INSERM Research Unit 664 and Cisbio Bioassays, Lyon, France
- 7Synarc, Lyon, France (past affiliation)
- 8Université Paris 7, UFR médicale, Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Unité de Recherche Clinique, Paris Cedex, France
- 9Assistance Publique-Hopitaux de Paris, Hôtel-Dieu Hospital, Surgery Department, Paris, France
- 10Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Endocrinology and Oncology Biochemistry Department, Paris, France
- 11Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
- Correspondence to Dr Pascal Richette, Fédération de Rhumatologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris cedex 10, France;
- Accepted 11 August 2010
- Published Online First 26 October 2010
Objective To investigate the effect of massive weight loss on (1) knee pain and disability, (2) low-grade inflammation and metabolic status and (3) joint biomarkers in obese patients with knee osteoarthritis (OA).
Methods 140 patients involved in a gastric surgery programme were screened for painful knee OA, and 44 were included (age 44 ± 10.3 years, body mass index (BMI) 50.7 ± 7.2 kg/m2). Clinical data and biological samples were collected before and 6 months after surgery.
Results Before surgery, interleukin 6 (IL-6) levels were correlated with levels of high-sensitivity C reactive protein (hsCRP) (p=0.006) and Helix-II (p=0.01), a biomarker of cartilage turnover, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (p=0.03). Surgery resulted in substantial decrease in BMI (−20%). Levels of insulin and insulin resistance were decreased at 6 months. Knee pain decreased after surgery (24.5 ± 21 mm vs 50 ± 26.6 mm; p<0.001), and scores on all WOMAC subscales were improved. Levels of IL-6 (p<0.0001), hsCRP (p<0.0001), orosomucoid (p<0.0001) and fibrinogen (p=0.04) were decreased after surgery. Weight loss resulted in a significant increase in N-terminal propeptide of type IIA collagen levels (+32%; p=0.002), a biomarker of cartilage synthesis, and a significant decrease in cartilage oligomeric matrix protein (COMP) (−36%; p<0.001), a biomarker of cartilage degradation. Changes in COMP concentration were correlated with changes in insulin levels (p=0.02) and insulin resistance (p=0.05).
Conclusion Massive weight loss improves pain and function and decreases low-grade inflammation. Change in levels of joint biomarkers with weight loss suggests a structural effect on cartilage.
The first two authors contributed equally to this work.
Funding Assistance Publique-Hôpitaux de Paris (APHP) and Direction of Clinical Research (PHRC N°0702 and CRC N° P050318), which promoted and supported the clinical investigation, and a grant from the European community (Collaborative Project ADAPT, contract number HEALTH-F262008-201100). This work was also supported by the ‘Association Rhumatisme et Travail’ (Hôpital Lariboisière, Paris, France).
Competing interests None.
Patient consent Obtained.
Ethics approval The ethics committee of the Hôtel-Dieu Hospital approved the clinical investigations.
Provenance and peer review Not commissioned; externally peer reviewed.