Comorbidities that impact management of osteoarthritis
- Karine Louati, MD
Karine Louati, MD
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Antoine Hospital, F-75012, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Pierre & Marie Curie University Paris 06 – INSERM UMR_S 938, Paris, France
- Francis Berenbaum, MD, PhD
Francis Berenbaum, MD, PhD
- Head of the Department of Rheumatology
- Team Leader: "Age-related joint diseases and metabolism"
- INSERM UMR-S938
- Faculty of Medicine Pierre & Marie Curie Paris VI
- Saint-Antoine Hospital, APHP
Osteoarthritis (OA) is the most common form of arthritis and can often be disabling in adults. Although many drugs are available for the symptomatic treatment of OA, the presence of comorbidities complicates management and remains a practical challenge. Both nonpharmacologic and pharmacologic interventions may require adaptation depending on the comorbidity.
This topic will review the management of OA in patients with common comorbidities. The pathogenesis and risk factors, diagnosis, clinical manifestations, and treatment of OA are presented separately. (See "Pathogenesis of osteoarthritis" and "Risk factors for and possible causes of osteoarthritis" and "Clinical manifestations and diagnosis of osteoarthritis" and "Overview of the management of osteoarthritis" and "Management of knee osteoarthritis" and "Management of moderate to severe knee osteoarthritis".)
The prevalence of comorbidities among patients with osteoarthritis (OA) is high. In a retrospective cohort study in Canada with 207,610 patients over 30 years old, 67 percent of those with OA had at least one comorbidity which included hypertension (prevalence ratio [PR] 1.17, 95% CI 1.15-1.19), depression (PR 1.26, 95% CI 1.22-1.30), chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% CI 1.11-1.21), and epilepsy (PR 1.27, 95% CI 1.13-1.13), even after adjustment for age and sex . There were insufficient data to calculate the prevalence of obesity and smoking, which were more commonly recorded among patients with OA than among those without. Diabetes is also a relatively common comorbidity among OA patients, with estimates of prevalence of approximately 15 percent . Other studies have shown that the metabolic syndrome is more frequent in OA patients compared with controls [3,4].
The prevalence of cardiovascular disease (CVD) among patients with OA is also high. A meta-analysis including over 32,000,000 OA patients found that they were twice as likely to have CVD . Several studies have also suggested that OA is associated with excess mortality risk due to CVD, diabetes mellitus (DM), obesity, cognitive disorders, and disability [6,7] (see "Overview of the management of osteoarthritis", section on 'Mortality'). In addition, pain secondary to OA may promote hypertension, obesity, and CVD by decreasing mobility (sometimes called the “sitting disease”).
MANAGEMENT CONSIDERATIONS FOR COMORBIDITIES
The presence of comorbidities in patients with osteoarthritis (OA) often impacts treatment choices, particularly with respect to pharmacologic therapy. Among these agents, the use of oral nonsteroidal antiinflammatory drugs (NSAIDs) is often limited due to the increased risk of adverse effects in patients with common comorbidities. Otherwise, the same general management principles of OA should apply, in that all patients should also engage in nonpharmacologic measures such as weight management and exercise, braces, walking aids, and psychological interventions as appropriate. It is worth noting that the beneficial effects of exercise and weight loss are not only limited to OA but are also advantageous for several other comorbidities.
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