Rheumatology Practice Changers 2014

Bret S. Stetka, MD; Stephen A. Paget, MD


December 18, 2014

In This Article

Important Considerations in Osteoarthritis

Findings from studies in 2014 have the potential to improve care in osteoarthritis (OA), the most common type of arthritis.

At this year's ACR meeting, a group from North Carolina presented a study[15] looking the association between poor physical function and mortality in patients with OA. Using data from the Johnston County Osteoarthritis Project, the investigators looked at 1525 individuals aged 45 years or older with radiographically confirmed (Kellgren-Lawrence grade ≥ 2) knee or hip OA and found that poor physical function among these individuals is associated with death, and that the findings are independent of comorbidities associated with increased mortality. The association was particularly strong in individuals with hip OA, suggesting a potential survival benefit through interventions encouraging improved physical function.

A major modifiable risk factor for knee OA is obesity. Although medical treatments can have limited beneficial effects in this condition, an alternative strategy is targeting weight loss to delay or avoid joint replacement. A group from New York University recently initiated a prospective study[16] to evaluate painful knee OA in obese patients and track whether weight loss after bariatric surgery affects OA-related pain and physical function. They screened consecutive patients (n = 537) before laparoscopic adjustable gastric banding, sleeve gastrectomy, or gastric bypass.

Their data suggested that bariatric surgery improves patients' knee OA pain in proportion to weight loss, with durability over time. Gastric bypass and sleeve gastrectomy have more impact on knee symptoms than does laparoscopic adjustable gastric banding. Although patients with worse Kellgren-Lawrence grades report more baseline pain and disability, disease severity on radiography did not affect the response to weight loss.

Despite the staggering financial and personal costs associated with OA, disease-modifying treatments have not been found as they have in RA and spondyloarthropathies, which are debilitating but much less common diseases. Today, OA is thought to be a reflection of organ failure, perhaps related to or exacerbated by neuromuscular dysfunction. It shortens life independent of comorbidities and magnifies the impact of obesity on life expectancy.

Because rheumatologists are often the principal caregivers for their patients, it is incumbent upon us to appreciate the impact of the disease on life span and ensure the best possible care and weight loss, even if that means bariatric surgery. The decision as to when joint vs bariatric surgery is needed should be individualized because their aims are the same.


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