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Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis
  1. Pascal Richette1,
  2. Christine Poitou2,3,4,5,
  3. Patrick Garnero6,7,
  4. Eric Vicaut8,
  5. Jean-Luc Bouillot9,
  6. Jean-Marc Lacorte10,
  7. Arnaud Basdevant2,3,4,5,
  8. Karine Clément2,3,4,5,
  9. Thomas Bardin1,
  10. Xavier Chevalier11
  1. 1Université Paris 7, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris Cedex, France
  2. 2Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Nutrition and Endocrinology Department, Paris, France
  3. 3Center of Research on Human Nutrition Ile de France, Paris, France
  4. 4INSERM, U872, Nutriomique Team 7, Paris, France
  5. 5Université Pierre et Marie Curie-Paris 6, Centre de Recherche des Cordeliers, UMRS 872, Paris, France
  6. 6INSERM Research Unit 664 and Cisbio Bioassays, Lyon, France
  7. 7Synarc, Lyon, France (past affiliation)
  8. 8Université Paris 7, UFR médicale, Assistance Publique Hôpitaux de Paris, Hôpital Fernand Widal, Unité de Recherche Clinique, Paris Cedex, France
  9. 9Assistance Publique-Hopitaux de Paris, Hôtel-Dieu Hospital, Surgery Department, Paris, France
  10. 10Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Endocrinology and Oncology Biochemistry Department, Paris, France
  11. 11Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
  1. Correspondence to Dr Pascal Richette, Fédération de Rhumatologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris cedex 10, France; pascal.richette{at}


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.

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  • 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.