Is osteoarthritis a metabolic disorder? S. Kluzek †, ‡ , J. L. Newton †, ‡,¶, *, and N. K. Arden †, ‡,§ † ARUK Sports, Exercise and Osteoarthritis Centre, University of Oxford, Oxford, UK, ‡ Oxford NIHR Musculo- skeletal Biomedical Research Unit, University of Oxford, Oxford, UK, § MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, and ¶ The Nuffield Department of Orthopaedics, Rheumatol- ogy and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK *Correspondence address. The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Old Road, Oxford OX3 7LD, UK. E-mail: julia.newton@ouh.nhs.uk Accepted 19 May 2015 Abstract Background: Obesity is associated with an increased risk of developing osteoarthritis (OA), even in non-weight bearing joints. High levels of adipose tissue-associated inflammation may explain this association. Sources of data and areas of debate: Published evidence looking at the associations between components of Metabolic Syndrome (MetS) and knee, hip or hand OA and the higher mortality described with knee OA. Emerging points: Development of MetS and OA shares a relationship with adipose tissue-associated inflammation. This review supports this inflamma- tory pathway being part of the shared mechanism behind obesity as a risk factor for OA and the recently described OA-associated increased mortality. Timely areas for development: In an era of an obesity epidemic, this review identifies a need for well-designed cohort studies assessing early metabolic changes in populations at high risk of OA and MetS, and to identify risk factors for increased mortality in patients with OA. Key words: osteoarthritis, metabolic syndrome, adipokines Introduction Osteoarthritis (OA) is the most common form of arthritis and musculoskeletal burden in the devel- oped world. The pathogenesis of OA is still poorly understood, but there is growing evidence that sys- temic inflammatory changes predispose patients to painful development of the disease. Although metabolic syndrome (MetS) has several specific definitions, it can be described as a com- bination of hypertension, dyslipidaemia, diabetes (or insulin resistance) and abdominal obesity. MetS has been associated with a state of chronic low-grade inflammation and an increased accumulation of macrophages in the fat tissue. 1 Development of both British Medical Bulletin, 2015, 115:111–121 doi: 10.1093/bmb/ldv028 Advance Access Publication Date: 14 July 2015 © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Downloaded from https://academic.oup.com/bmb/article/115/1/111/260277 by guest on 19 March 2023