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Extended report
Progressive increase in body mass index is not associated with a progressive increase in joint space narrowing in obese women with osteoarthritis of the knee
  1. M-P Hellio Le Graverand1,
  2. K Brandt2,
  3. S A Mazzuca2,
  4. D Raunig1,
  5. E Vignon3
  1. 1
    Pfizer Global Research and Development, New London, Connecticut, USA
  2. 2
    Indiana University School of Medicine, Indianapolis, USA
  3. 3
    Claude Bernard University Lyon I, Lyon, France
  1. Correspondence to Dr E Vignon, Service de Rhumatologie, Centre Hospitalier Lyon Sud, Chemin du Grand Revoyet, 69495 Pierre Benite, Lyon 69495, France; eric.vignon{at}


Objective: Given that obesity is a risk factor for osteoarthritis (OA) of the knee, a study was undertaken to determine whether progressively higher body mass index (BMI) among obese women is associated with progressive increases in joint space narrowing (JSN).

Methods: Medial compartment JSN over 12 months in Lyon Schuss radiographs of 60 obese women (BMI 30.0–50.5 kg/m2) with radiographic and symptomatic OA was compared with that in 81 non-obese women (BMI <28 kg/m2) with normal radiographs and minimal or no symptoms of knee OA.

Results: Among the patients with OA, higher BMI tended to be associated with a higher Kellgren and Lawrence (KL) grade of OA severity. JSN in the non-obese controls was negligible, but in the 30 patients with KL grade 2 and KL grade 3 knees, mean (SD) JSN was 0.12 (0.31) mm and 0.32 (0.50) mm, respectively (p<0.005 and p<0.001). No association was seen between baseline BMI and 12-month JSN in patients with OA; indeed, the regression plot suggested a slight inverse relationship between the two.

Conclusions: In obese patients with OA, progressively higher BMI values were not accompanied by a progressively increasing rate of JSN. Joint loading was not evaluated, but it is possible that marked obesity limited the functional capacity of some subjects with OA, protecting their knees from loading. For investigators considering eligibility criteria for a trial of a structure-modifying OA drug, these data suggest that recruitment of patients with a BMI much higher than 30 kg/m2 will not enrich the sample of subjects who will have more rapid JSN than those with a BMI of only 30 kg/m2.

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  • Funding Pfizer Global Research & Development

  • Competing interests M-PHLG is employed by Pfizer Inc. EV receives grant support from Pfizer. KDB provides consulting services to Pfizer. SAM receives grant support from and provides consulting services to Pfizer.

  • Ethics approval The study was conducted in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with local Institutional Review Board, informed consent regulations and International Conference on Harmonization Good Clinical Practices Guidelines.

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