Berna GÖKER, Mukadder ERDEM, Mehmet Derya DEMİRAĞ, Berna GÜZEL, Düriye Sıla KARAGÖZ ÖZEN, Nizamettin GÜZEL

Associations between the radiographic phenotypes and the presence of metabolic syndrome in patients with knee osteoarthritis

Background/aim: We aimed to investigate the associations between the radiographic phenotypes and the presence of metabolic syndrome (MetS) in patients with knee osteoarthritis (OA).Materials and methods: We evaluated women age 40 and over who presented to our outpatient clinics with knee pain and fulfilled the clinical and radiographic criteria for the classification of idiopathic OA of the knee. Patients were categorized into two groups concerning dominant radiographic phenotype. We included consecutive 50 patients in each group. All patients were evaluated in terms of MetS according to the revised diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), as well as the World Health Organization (WHO).Results: Overall, MetS prevalence was found to be 79% according to the NCEP ATP III-MetS criteria and 65% according to the WHOMetS criteria. Prevalence of MetS was higher in the joint space narrowing (JSN)-dominant group compared to the osteophyte (O)- dominant knee OA group, but the difference did not reach statistical significance. However, in subgroup analysis (54 patients) in which we excluded patients with a past medical history of type 2 diabetes mellitus (DM), the prevalence of NCEP ATP III-MetS was statistically significantly higher in the JSN-dominant group compared to the O-dominant group [22 (75.9%) vs. 12 (48%), respectively, p = 0.03]. Logistic regression analysis in the subgroup demonstrated that the presence of NCEP ATP III-MetS was an independent risk factor for JSN-dominant knee OA phenotype [OR and 95% CI = 3.48 (1.09–11.13)].Conclusion: The prevalence of MetS is quite high in patients with knee OA and is particularly pronounced in patients with JSNdominant radiographic phenotype. Moreover, our results suggest that MetS is an independent risk factor for JSN-dominant knee OA in patients with no past medical history of DM. Key words: Osteoarthritis, knee, metabolic syndrome

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1. Chen L, Zheng JJY, Li G, Yuan J, Ebert JR et al. Pathogenesis and clinical management of obesity-related knee osteoarthritis. Impact of mechanical loading. Journal of Orthopedic Translation 2020; 24:66-75. doi: 10.1016/j.jot.2020.05.001
2. Wen L, Kang JH, Yim YR, Kim JE, Lee JW et al. Associations between body composition measurements of obesity and radiographic osteoarthritis in older adults. Data from the Dong-gu Study. British Medical Journal Musculoskeletal Disorders 2016; 17:192. doi: 10.1186/s12891-016-1040-9
3. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. Definition of metabolic syndrome. Circulation 2004;109(3):433-8. doi: 10.1161/01.CIR.0000111245.75752.C6
4. Alberti KG, Zimmet PZ. Definition, diagnosis, and classification of diabetes mellitus and its complications. Part 1 diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic Medicine 1998; 15:539–553. doi: 10.1002/(SICI)1096-9136(199807)15:7<539:AIDDIA668>3.0.CO;2-S
5. Yerima A, Adelowo O. Knee osteoarthritis and associated cardio-metabolic clusters in a tertiary hospital in Nigeria. Clinical Rheumatology 2017;36(11):2541-2548. doi: 10.1007/ s10067-017-3816-1
6. Maddah S, Mahdizadeh J. Association of Metabolic Syndrome and Its Components with Knee Osteoarthritis. Acta Medica Iranica 2015;53(12):743-8
7. Demirağ MD, Özkan S, Haznedaroğlu Ş, Aras Kilinç E, Baran Aksakal FN et al. Associations between obesity and the radiographic phenotype in knee osteoarthritis. Turkish Journal of Medical Sciences 2017; 47(2):424-429.doi: 10.3906/sag1512-26
8. Altman R, Asch E, Bloch D, Bole G, Borenstein D et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheumatology 1986;29:1039-1049. doi: 10.1002/ art.1780290816
9. Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007;15 Suppl: A1-56.doi: 10.1016/j.joca.2006.11.009
10. Onat A, Yüksel M, Köroğlu B, Gümrükçüoğlu HA, Aydın M et al. TEKHARF 2012: Genel ve koroner mortalite ile metabolik sendrom prevalansı eğilimleri [Turkish Adult Risk Factor Study survey 2012. overall and coronary mortality and trends in the prevalence of metabolic syndrome]. Türk Kardiyoloji Derneği Arşivi 2013;41(5):373-8. doi: 10.5543/tkda.2013.15853
11. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/ IDF Consultation. Geneva, World Health Org. 2006
12. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004;27(6):1487-95. doi: 10.2337/ diacare.27.6.1487
13. Xie Y, Zhou W, Zhong Z, Zhao Z, Yu H et al. Metabolic syndrome, hypertension, and hyperglycemia were positively associated with knee osteoarthritis, while dyslipidemia showed no association with knee osteoarthritis. Clinical Rheumatology 2021;40(2):711-724. doi: 10.1007/s10067-020-05216-y
14. Li S, Felson DT. What is the evidence to support the association between metabolic syndrome and osteoarthritis? A systematic review. Arthritis Care and Research (Hoboken) 2019;71(7):875- 884. doi: 10.1002/acr.23698
15. Niu J, Clancy M, Aliabadi P, Vasan R, Felson DT. Metabolic syndrome, its components, and knee osteoarthritis: The Framingham osteoarthritis study. Arthritis Rheumatology 2017;69(6):1194-1203.doi: 10.1002/art.40087
16. Sanchez-Santos MT, Judge A, Gulati M, Spector TD, Hart DJ et al. Association of metabolic syndrome with knee and hand osteoarthritis: A community-based study of women. Semin Arthritis Rheumatology 2019; 48: 791-798.doi: 10.1016/j. semarthrit.2018.07.007
17. Shin D. Association between metabolic syndrome, radiographic knee osteoarthritis, and intensity of knee pain: results of a national survey. Journal of Clinical Endocrinology and Metabolism 2014 ;99(9):3177-83. doi: 10.1210/jc.2014- 1043
18. Engström G, Gerhardsson de Verdier M, Rollof J, Nilsson PM, Lohmander LS. C-reactive protein, metabolic syndrome, and incidence of severe hip and knee osteoarthritis. A populationbased cohort study. Osteoarthritis Cartilage 2009 ;17(2):168- 73. doi: 10.1016/j.joca.2008.07.003
19. Hart DJ, Doyle DV, Spector TD. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheumatology 1999 ;42(1):17-24. doi: 10.1002/1529-0131(199901)42:1<17::AIDANR2>3.0.CO;2
20. Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Annals of Rheumatic Diseases 1994;53(9):565-8. doi: 10.1136/ard.53.9.565
21. Pan F, Tian J, Mattap SM, Cicuttini F, Jones G. Association between metabolic syndrome and knee structural change on MRI. Rheumatology (Oxford) 2020;59(1):185-193. doi: 10.1093/rheumatology/kez266
22. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Annals of Rheumatic Diseases 1957;16(4):494- 502.doi: 10.1136/ard.16.4.494