Study of effect of weight reduction on primary osteoarthritis hand and knee in obese patient.
and a role in the pathogenesis of osteoarthritis. (7)
AIMS: This work was carried out with an aim directed to Study the effect of weight reduction on osteoarthritis of knee and hand in obese patients. The purpose of the present study is to determine the relationship between hand osteoarthritis, Knee osteoarthritis and obesity for understanding the etiology.
1. To establish the relationship between Primary osteoarthritis of hand, Knee and obesity.
2. To note the clinical effect of weight reduction on osteoarthritis of hand and Knee.
3. To note the Clinical changes in the above joints after weight reduction.
MATERIALS AND METHODS:
Inclusion criteria: Primary osteoarthritis of Knee, and hand up to grade III.
Female obese patients with Primary osteoarthritis of Knee and hand who are willing to reduce weight were included. Patients who were willing to participate in study.
* Unwilling or unable to change eating habits and physical activity and
* Significant cognitive impairment.
* Not willing to give written consent Patients of systemic disease and infectious disease.
* Secondary osteoarthritis of Knee and hand.
METHODS: 50 female patients were included in the study who had clinically diagnosed osteoarthritis of knee and hand, divided into two groups after taking informed written consent. Both groups were investigated for pain, X-ray (Knee/hand), lipid profile and weight and height. The patients were screened for DM, hypertension, or any other chronic illness.
Group I was treated by only NSAID. This was the control group.
Group II was treated with reduction in weight and NASID, Study group.
All patients clinically diagnosed as Osteoarthritis of Knee and Hand were subjected to Radiography which were studied for the presence of osteoarthritis and graded according to Kellgren- Lawrence grading system.
Grade 0: Normal.
Grade I: Minute osteophytes of doubtful significance.
Grade II: Definite osteophytes mild reduction in joint space.
Grade III: Moderating narrowing of joint space.
Grade IV: Greatly reduced joint space and subchondral bone sclerosis.
BMI was monitored at WHO classification of BMI by using formula;
BMI=weight in kg/height in [cm.sup.2].
BMI-Normal range-18.50-24.99, Overweight [greater than or equal to] 25, Obese [greater than or equal to] 30.
Pain: Pain was assessed at Numerical rating scale (NRS).
All patients are to have a functional activity score recorded:
A. No limitation meaning the patient's activity is unrestricted by pain.
B. Mild limitation means the patient's activity is mild to moderately restricted by pain.
C. Severe limitation means the patient ability to perform the activity is severely limited by pain.
Numerical Rating Scale (NRS): Instruct the patient to choose a number from 0 to 10 that best describes their current pain.0 would mean 'No pain' and 10 would mean 'Worst possible pain'.
STUDY DESIGN: Present study is prospective randomised control study was undertaken in the department of Orthopaedics PCMS, Bhopal.50 cases fulfilling the inclusion criteria were included in the study. The duration of study was 1 years. The statistical analysis was done by Mann whitne 'u' test and SPSS 20.0 software was used. The association between Osteoarthritis and incremental increase in BMI will be carried out using multiple regression analyzing using SPSS 20.0 computer package.
RESULT: During the study 50 female patients who had osteoarthritis with obesity were included. Patients were divided into two group, Group I or control group were included 20 patients with clinically diagnosed osteoarthritis of knee and hand and were not willing to reduce weight. Patients of control group were treated with NSAID. In group II or study group 30 patients were included who were willing to reduce weight, patients of group II also were prescribed NSAID initially for pain.
In control group at the time of registration mean weight was 68.85 [+ or -] 3.801 and mean BMI 28.9 [+ or -] 1.522.Pain score of patients at Numerical rating scale was measured, out of 20 patients. Twelve patients (60%) were scored at 8 and eight patients (40%) were scored at 7. All these patients were treated with NSAID after 7 days, ten (50%) patients had 2, One patient (5%) had1 and nine (45%) had 3 score at numerical pain scale. All these patients required NSAID frequently for pain throughout the study and pain of maximum patients was measured between 3-4 at pain Numerical rating scale invariably during the study. All patients clinically diagnosed as osteoarthritis of Knee / and Hand were radiological studied for the presence of osteoarthritis and graded according to Kellgren-Lawrence grading system. At first visit, eleven (55%) patients had grade II and nine (45%) patients had grade I osteoarthritis of knee. At the end of study maximum patients were deteriorate from grade II to grade III. Fourteen (70%) patients were investigated for grade I and six (30%) patients were for grade II osteoarthritis hand. At first visit and at the end of study eight (40%) patients had grade II and eight (40%) grade III osteoarthritis and four (20%) patient had no change in grade.
In group II or study group, 30 patients were included who were willing to reduce weight. Mean age 51.866 [+ or -] 6.4097, mean weight 69.2 [+ or -] 2.917 and mean BMI was 29.11 [+ or -] 1.26405 at the time of registration. All the patients were subjected to reduce weight. At the time of first visit ten (33.33%) patients had BMI between 30-35 and twenty (66.66%) patients had BMI between 25-30. At Second visit twenty eight (93.33%) patients had BMI between 25-30 and two (6.6%) patient had BMI between 24-25. Fifteen (50%) patients had BMI between 25-30 and 15(25%) had between 20-25 at third visit. At the end of study all the patients had reduced weight and had BMI less than 25, mean BMI was 23.04967 [+ or -] 0.787254 and p=<0.0001.Out of 30 patients, fourteen (46.66%) patients were scored for pain8, eleven (36.66%) patients for 7, four (13.33%) patients for 9 and one(3.33%) patients for 6 at pain Numerical rating scale. All these patients were treated by NSAID for pain. At second visit, nineteen (63.33%) at 3, nine (30%) patients at 2 and two (6.66%) patients had score 1. one (6.66) patients was required NSAID for pain throughout the study and five (16.66%) patients needed add on NSAID. All the patients were subjected to X-Ray at the time of registration fourteen (46.66%) patients had grade II and sixteen (53.33%) had grade I osteoarthritis of knee. Twenty seven patients had grade I osteoarthritis of hand and only three patient had grade II osteoarthritis of hand. During the study on X-Ray there was no significant change seen in hand and knee X-ray and clinically all the patients were improved in function and pain.
DISCUSSION: The purpose of present study is to evaluate the prognosis of osteoarthritis in obese patient after weight reduction and establish relationship between Primary osteoarthritis of hand, Knee and obesity. Osteoarthritis is the major chronic metabolic disorder leading to musculoskeletal morbidity and functional loss, its effects increasing with age.
Obesity is a global health issue, with 315 million adults are classified as obese, defined as a body mass index (BMI) of [greater than or equal to] 30 kg/[m.sup.2]. (8,9) As BMI values increase, joint pain symptoms and severity increase (10) is comparable to our study in our study we found in control group severity of osteoarthritisis increased, and patients of control group required drugs therapy for pain. Joint pain may reflect the underlying pathological process of osteoarthritis. For every 5kg weight gain, there is a commensurate 36% increased risk for developing osteoarthritis. (11) In obese individuals, pain is most prevalent in the load-bearing joints including the lower limb and the low back, (11,12) but can manifest in upper extremity joints, hand and digits. (12) Obesity is associated with faster osteoarthritis progression than normal weight. Pain-related physical incapacitation worsens obesity, subsequent gait abnormalities and muscle weakness. (13) Importantly, pain may mediate obesity-induced impairment of physical functioning and deterioration of health-related quality of life. (14-13) Weight loss sets in motion a cascade of events that can prevent osteoarthritis onset or combat existing osteoarthritis symptoms and disability, these events include reduction of mechanical and biological stressors. In our study we found relationship between osteoarthritis and obesity. The patients who reduced weight, they had no change in X-ray grading, improvement in pain, joint movement and Improve the quality of life. However, being overweight does not necessarily increase load across joints in the hand, suggesting involvement of other factors. In our study we found X-ray grading hand of test group were not changed significantly. In control group 70% patients were investigated for grade I and 30% patients were for grade II osteoarthritis of hand at first visit and at the end of study 40% patients had grade II and 8(40%) grade III osteoarthritis and 4(20%) patient had no change in grade. There is increasing evidence that systemic factors such as chronic inflammation or other metabolic processes are involved in development or progression of osteoarthritis.
In several study Obesity is considered to be one of the most important risk factors for osteoarthritis in knee. Numerous longitudinal studies show a strong association between obesity, defined as a body mass index(BMI) above 30, and radiographic knee osteoarthritis, e.g. in the Framingham Study, (15) the Chingford Study (16), the Baltimore Longitudinal Study of Aging, (17) the John Hopkins Precursors Study, (18) and in longitudinal studies in UK (19) and the Netherlands. (20) Thus, the WHO initiative on counteracting obesity also accepts osteoarthritis as a consequence of obesity (21) However, the relationship between obesity and osteoarthritis in hand and hip remains controversial.^2'23) Large cross-sectional studies have failed to show a significant association between obesity and hand osteoarthritis in either males or females, whereas some prospective data have demonstrated that obesity predicted hand osteoarthritis.
CONCLUSION: This study showed a relationship between osteoarthritis of knee and hand with Obesity. Prevention of osteoarthritis may be achieved by maintain normal body weight and prognosis of osteoarthritis can be improved by reduce body weight. This study further need to establish a relationship between osteoarthritish and role of biochemical stressors.
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V. K. Verma , Hemlata Verma , H. Rao , U. S. Shukla , T. N. Singh Gaur 
[1.] V. K. Verma
[2.] Hemlata Verma
[3.] H. Rao
[4.] U. S. Shukla
[5.] T. N. Singh Gaur
PARTICULARS OF CONTRIBUTORS:
[1.] Associate Professor, Department of Orthopaedics, PCMS, & RC Bhopal.
[2.] Assistant Professor, Department of Pharmacology, Gandhi Medical College, Bhopal.
[3.] Professor & HOD, Department of Orthopaedics, PCMS, & RC Bhopal.
[4.] Assistant Professor (Statics), Department of Community Medicine, Government Medical College, Jhalawar.
[5.] Assistant Professor, Department of Orthopaedics, PCMS, & RC Bhopal.
FINANCIAL OR OTHER COMPETING INTERESTS: None
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. V. K. Verma, HIG, C-6, PCMS Campus, Bhanpur, Bhopal.
Date of Submission: 02/06/2015. Date of Peer Review: 03/06/2015. Date of Acceptance: 15/06/2015. Date of Publishing: 22/06/2015.
Table 1: Distribution of BMI in different time Periods in different Group Group Statistics Group N Mean Std. Deviation BMI Base Test 30 29.1153 1.26405 line Control 20 28.9 1.52281 BMI After Test 30 27.167 1.2292 3 Months Control 20 28.9 1.52281 BMI After Test 30 25.0907 1.03226 6 Months Control 20 28.9 1.52281 BMI After Test 30 23.0497 0.78725 1 Years Control 20 30.33 0.13416 Group T Value P value BMI Base Test 0.544 0.589 line Control BMI After Test 3 Months Control 4.4 37 <0.0001 * BMI After Test 6 Months Control 10.559 <0.0001 * BMI After Test 1 Years Control 40.828 <0.0001 * Table 2: Distribution of Pain in different time Periods in different Group Ranks Group N Mean Sum of U Value P value Rank Ranks Pain Score Test 30 26.17 785 280 0.659 1st visit Control 20 24.5 490 Total 50 Pain Score Test 30 28.45 853.5 211.5 0.046 * after 1 week Control 20 21.08 421.5 Total 50 Pain Score Test 30 19.67 590 125 <0.0001 * after 2 week Control 20 34.25 685 Total 50 Table 3: Distribution of X--ray Knee in different time Periods in different Group Ranks Group N Mean Sum of U Value P value Rank Ranks X-ray knee Test 30 24.67 740 after 1 week Control 20 26.75 535 275 0.568 Total 50 X-ray knee Test 30 24.67 740 after 6 months Control 20 26.75 535 275 0.568 Total 50 X-ray knee Test 30 18.3 549 after 1 Years Control 20 36.3 726 84 <0.0001 * Total 50 Table 4: Distribution of X-ray Hand in different time Periods in different Group Ranks Group N Mean Sum of U Value P value Rank Ranks X-ray hand Test 30 24 720 255 0.161 after 1 week Control 20 27.75 555 Total 50 X-ray hand Test 30 24 720 255 0.1 61 after 6 months Control 20 27.75 555 Total 50 X-ray hand Test 30 24 720 255 0.1 61 after 1 Years Control 20 27.75 555 Total 50
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Verma, V.K.; Verma, Hemlata; Rao, H.; Shukla, U.S.; Gaur, T.N. Singh|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jun 22, 2015|
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