Mehmet SARGIN, Şevin DEMİR, Zeki TAŞDEMİR, Oya TAŞDEMİR

Kilo Vermenin Bel ve Diz Ağrılarına Etkisi

Amaç: Semptomatik osteoartrit (OA) ‘in risk faktörleri değerlendirildiğinde yüksek vücut kitle indeksi(VKİ) ‘nin, düşük eğitim düzeyi ve sosyal desteğin, depresif durumun daha fazla ağrı bildirilmesi ileilişkili olduğu görülmüştür. Bu çalışmanın amacı, obez ve semptomatik diz osteoartriti ve bel ağrısı olanhastalarda; radyolojik evre ve vücut kitle indeksi ile fonksiyonel durum arasındaki ilişkiyideğerlendirmekti.Materyal ve Metot: Çalışmaya diz ağrısı yakınması nedeniyle başvuran primer diz OA tanısı alan VKİ30 kg/m2üstü 41 hasta dahil edildi. Anatomik tibiofemoral açı (aTFA), ortoröntgenografiler üzerindeResim Arşivleme İletişim Sistemleri (PACS) ile ölçüldü. Ağrı yakınması daha çok olan dize göre WesternOntario McMaster Osteoartrit Indeksi (WOMAC) ve görsel ağrı skalası (VAS) ile değerlendirildi.Bulgular: VKİ’deki düşme ile bel ağrısı VAS’daki (0‐3.Ay Fark) düşme arasında pozitif yönde istatistikselolarak anlamlı korelasyon gözlenmiştir. Fakat VKİ’deki değişim ile diz fonksiyonları ve VAS arasındapozitif yönde düşme gözlenirken istatistiksel olarak anlamlı bulunmamıştır.Sonuç: Obez diz osteoartiritine bağlı kısa dönem diz ağrılarının kilo vermek ile direk bağlantısı olmayıp,fazla kilonun yol açtığı geri dönüşümü olmayan mekanik faktörlerin (dizin aşırı varusu, diz eklemindekikıkırdak hasarı) etken olduğunu düşündürmüştür.

The Impact of Weight Loss on Lumbar and Knee Pain

Objectives: When the risk factors of symptomatic osteoarthritis (OA) are evaluated, it has been shown that increased body mass index, lower educational levels and social support, depressive mood are associated with reporting more pain. The aim of this study was to investigate the relationship with radiological grade of osteoarthritis of knee at symptomatic obese patients and body mass index, functional status. Materials and Methods: Forty‐one patients whose BMI was more than 30 kg/m2 and diagnosed as primary knee OA due to knee pain complaints were included in the study. The anatomic tibiofemoral angle (aTFA) was measured on orthoro‐ entgenography by Picture Archiving Communication Systems (PACS). Western Ontario McMaster Osteoarthritis Index (WOMAC) and knee Visual Analogue Scale (VAS) were evaluated according to the knee which has more pain complaint. Results: A statistically significant correlation in the positive direction was found between the decrease in BMI and the decrease in the Lumbar VAS (Initial‐3rd month difference). However, there was a correlation between the decrease in BMI and the decrease in knee function and VAS which was not statistically significant. Conclusion: It is suggested that short term knee pain due to knee OA is not directly associated with weight loss and irreversible mechanical factors (knee varus, cartilage damage in knee joint) caused by obesity can be the effective factor.

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1. Jordan JM, Hochberg MC, Silman AJ, Smolen JS, Weinblatt MR, Weisman MH. Epidemiology and classification of osteoarthritis. Rheumatology. 4th ed. Spain: Mosby Elsevier; 2008:1691‐701.
2. Szebenyi B, Hollander AP. Dieppe P et al. Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheumatol 2006;54(1):230‐5.
3. Thumboo J. Chew LH, Lewin‐Koh SC. Socioeconomic and psychosocial factors influence pain or physical function in Asian patients with knee or hip osteoarthritis. Ann Rheum Dis 2002;61(11):1017‐20.
4. Duncan R, Peat G, Thomas E, Hay E, McCall I, Croft P. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be. Ann Rheum Dis 2007:66(1);86‐91.
5. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt, LW. Validation study of WOMAC: a health status instrument formeasuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15(12):1833‐40.
6. Paley D. Radiographic assessment of lower limb deformities. In: Paley D, Herzberg JE, (editors). Principles of deformity correction. Berlin: Springer‐Verlag; 2002:31‐60.
7. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P. Axiallower‐limbalignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 1997;5:39‐47.
8. Kellgren JH, Lawrence JS. Radiological assessment of osteo‐arthrosis. Ann Rheum Dis 1957;16(4):494.
9. Petersson IF, Boegård T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlbäckand Kellgren& Lawrence systems for the tibio femoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis 1997;56(8):493‐6.
10. Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol 2001;13(5):447‐51.
11. Slemenda C, Brandt KD, Heilman DK et al. Quadriceps weakness and osteoarthritis of the knee. Annals of internalmedicine 1997;127(2):97‐104.
12. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000;27(6):1513‐7.
13. Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR. Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol 1992;19(12):1943‐9.
14. Rosemann T, Kuehlein T, Laux G, Szecsenyi J. Osteoarthritis of the knee and hip: a comparison of factors associated with physical activity. Clin Rheumatol 2007;26(11):1811‐7.
15. Atamaz F, Hepgüler S, Öncü J. Factors associated with pain and disability in knee osteoarthritis. Turk J Phys Med Rehab 2006;52(3):119‐22.
16. Evcik D, Kuru I, Maralcan G, Evcik E. Relationship between the mechanical and anatomic axis and orientation angles of the knee joint and functional capacity of patients with osteoarthritis. Acta Orthop Traumatol Turc 2006;40(1):38‐43.
17. Prodromos CC, Andriacchi TP, Galante JO. A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg. American volume 1985;67(8):1188‐94.
18. Hurwitz D,Ryals AR, Block JA, Sharma L, Schnitzer TJ, Andriacchi TP. Knee pain and joint loading in subjects with osteoarthritis of the knee. J Orthop Res 2000;18(4): 572‐79.
19. Samancı N, Kaçar C, Sayın M, Tuncer T. Primer diz osteoartritinde metabolik, endokrin ve sosyo‐kültürel risk faktörleri ve radyolojik bulgularla ilişkisi. Romatizma 2003;18:92‐8.
20. Manninen P, Riihimäki H, Heliövaara M, Mäkelä P. Overweight, gender and knee osteoarthritis. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity 1996:20(6), 595‐7.
21. Siegler BC, Marshall JC, Paul WM. Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study. BMC Public Health 2016;16(1):700.
22. Hussain SM, Urquhart DM, Wang Y et al. Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study. Arthritis ResTher 2017;19(1):26.