Osteoarthritis, arterial hypertension and obesity: the problem of comorbidity

In the literature of recent years, the notion of comorbidity - the simultaneous destruction of two or more organs and systems of the body - is widely covered. Comorbidity can proceed according to the type of synthropy - lesions of organs under the influence of common pathogenetic factors or interference - the occurrence of one disease under the influence of another. Despite the large number of different definitions of comorbidity, the meaning of the term most fully reflects the following: under diseases or disorders that are comorbid with a particular disease, we mean those disorders that occur most often in this disease and have some joint etiological or pathogenetic mechanisms with it.

Recently, the attention of scientists is attracted by the problem of combining various joint diseases in patients with metabolic and cardiovascular disorders. In patients with osteoarthritis (OA), in combination with the metabolic syndrome (MS), significant lipid metabolism disorders were detected, an increase in oxidative stress activity, which contributed to the degradation of the connective tissue structures of the body. Patients with osteoarthritis have an increased risk of developing cardiovascular pathologies, which increases during treatment with nonsteroidal anti-inflammatory drugs in the presence of other factors - age-related changes, obesity and hypertension (AH). For example, according to IO Romanova, 62% of patients with osteoarthritis had AH and an increase in the level of C-reactive protein in blood, the degree of which depends on the risk factors for the development of cardiovascular disorders, pain syndrome and stage of the disease. Also, patients suffering from osteoarthritis were found to have endothelial dysfunction and impairment of its functions-a decrease in the antithrombogenic activity of the vascular wall, an increase in the elasticity of the arteries, the severity of which increases with the duration of the disease.

According to the results of the research of American scientists, osteoarthritis is one of the main problems of the health protection system, primarily because of its connection with cardiovascular diseases, which become one of the main causes of death of patients. To date, there is much evidence that osteoarthritis is not just a disease associated with violations of the morphofunctional state of the joints, but a metabolic disorder in which metabolic disorders develop that contribute to the onset and progression of the systemic pathological process. Thus, the development of OA is associated not only with obesity and hypertension, but also with other factors of cardiovascular risk - diabetes, insulin resistance and dyslipidemia. Scientists from the United States studied the prevalence of metabolic syndrome in patients with osteoarthritis in 7,714 patients due to metabolic disorders and the development of systemic inflammation. It was found that osteoarthritis is associated with an increase in the prevalence of metabolic syndrome mainly at a young age. According to the study, MS was common in 59% of patients with osteoarthritis and 23% of patients without osteoarthritis and included: hypertension (75% vs 38%), abdominal obesity (63% vs. 38%), hyperglycaemia (30% vs. 13%) , elevated triglyceride levels (47% vs. 32%) and low levels of low-density lipoproteins (44% vs. 38%). MS was most often found in patients with osteoarthritis, regardless of sex and race. The relationship between osteoarthrosis and metabolic syndrome was noted in young patients, and decreased with age. Scientists from the University of California studied obesity and cardiovascular risk in patients with osteoarthritis during 2002-2006. 6299 adult patients under the age of 35 years were examined. Osteoarthritis was detected in 16.5% of women and 11.5% of men, while the number of patients increased with age and was higher among women. The presence of pain syndrome in osteoarthritis was associated with the degree of obesity, AH - with smoking patients. In men, there was no association of diabetes mellitus with osteoarthritis, in women the combination of diabetes and osteoarthritis was diagnosed at the age of 35 to 54 years. Thus, the prevalence of osteoarthritis and associated pathologies among the US population was significant.

Great importance in assessing the clinical status of patients with osteoarthritis in combination with arterial hypertension and obesity has a body mass index (BMI). It is known that obesity mainly develops osteoarthritis of the knee joints, to a lesser extent - hip joints. The relationship between BMI, the number of affected joints and the radiographic progression of osteoarthritis was also established. Excess body weight (BMI> 25) was associated with an increased incidence of osteoarthritis of knee joints, rather than hip joints. With BMI more than 27.5 roentgenologically, only osteoarthritis of the knee joints progresses. Evidence of the effect of obesity on the development of coxarthrosis is ambiguous: some authors confirm a possible association of these pathologies, others do not. In a study of 298 patients with osteoarthrosis of the knee and hip joints, BMI was calculated, the circumference of the waist and hips was measured, and the relationship of these indices to the severity of osteoarthritis was studied. As a result, it was found that obesity was observed in 61.5% of women and 59% of men. In these patients, there was an obvious increase in the spread of cardiovascular diseases and diabetes mellitus among patients with a higher BMI. The results confirm the important role of obesity as a risk factor in the development of osteoarthritis. Metabolic disorders of lipid metabolism affect the development of concomitant pathologies and are important in the progression of osteoarthritis of the knee joints.

A group of Brazilian scientists studied concomitant pathologies in patients with osteoarthritis. It is established that the prevalence of OA increases with age. 91 patients were examined (mean age 59.3 years, 91.4% were women). Metabolic syndrome was diagnosed in 54.9% of patients, AH in 75.8%, dyspepsia in 52.6% and obesity in 57.1% of patients. Depression was observed in 61.3% of OA patients. Depression, metabolic syndrome or some of its components affect the intensity of the pain syndrome and the physical condition of patients, which indicates the need to study and treat co-morbidities in patients with osteoarthritis.

Swedish researchers have studied the relationship between the C-reactive protein level, the metabolic syndrome and the frequency of osteoarthritis of the knee and hip joints: an increased incidence of osteoarthritis of the knee joints in patients with MS in most cases was due to elevated BMI, and the level of C-reactive protein in the blood was not associated with the development of osteoarthritis.

Norwegian scientists have studied a group of 1854 patients with a combined pathology - obesity and osteoarthrosis. The age of the patients ranged from 24 to 76 years, obesity was defined as a BMI above 30.0. As a result, a high BMI was significantly associated with gonarthrosis, rather than coxarthrosis.

In scientific studies of Italian scientists, clinical manifestations of concomitant diseases in osteoarthritis were determined. A total of 25,589 patients were examined, including 69% of women and 31% of men. The most frequent concomitant pathologies in osteoarthritis were AH (53%), obesity (22%), osteoporosis (21%), type 2 diabetes (15%) and chronic obstructive pulmonary disease (13%). The pain syndrome in osteoarthritis was more pronounced in women than in men. Thus, the results of this study emphasize the high incidence of concomitant diseases, as well as the role of various factors in the development of pain syndrome in osteoarthritis.

In the studies of domestic scientists the problem of diagnosis and treatment of osteoarthritis combined with other pathologies is considered and developed by specialists in both therapeutic and orthopedic profiles. According to VA Filippenko et al., With osteoarthritis, there is an imbalance in the synthesis of cytokines and other immunological disorders that underlie the formation of a chronic inflammatory process in the joints. According to our studies, patients with osteoarthrosis have abnormalities in the hemostasis system, which are manifested by an increase in the concentration of fibrinogen in the plasma, soluble fibrin-monomer complexes, and an increase in fibrinolytic activity. When examining patients with osteoarthritis with obesity and hypertension, in addition to increasing the concentration in the blood of cholesterol and beta-lipoproteins, there was an increase in the level of biochemical indicators of the state of connective tissue (glycoproteins, chondroitin sulfates), which indicates a high activity of the systemic inflammatory process in the body, enhanced by concomitant diseases.

According to IE Koroshina, MS was determined in 82.3% of patients with osteoarthritis. In patients with metabolic syndrome, osteoarthritis often developed a lesion of the cardiovascular system, gastrointestinal tract, kidney and thyroid gland, as well as diabetes mellitus, obesity and concomitant diseases. Thus, metabolic disturbances in OA may indicate their involvement in the development and progression of the disease.

According to the results of the research, I. V. Soldatenko et al. Clinical features, heart rate variability and the effectiveness of comorbid control with OA AG, depending on the types of orthostatic response and diurnal blood pressure profiles, were established. Combined with OA AG did not affect the initial indices of heart rate variability, but at the same time violated the reaction to orthostasis. Among the set of studied clinical signs and heart rate variability indices, the age of patients and the sympathetic-vagal balance were statistically significant criteria for the effectiveness of blood pressure monitoring in patients with AH comorbid with osteoarthritis.

According to LM Pasiyshvili, in patients with hypertensive disease, hypocalcemia and hypercalciuria were defined, which significantly increase when osteoarthrosis is attached. The revealed changes can be considered as one of the mechanisms of development and progression of these pathologies. These changes are an unfavorable factor in the combined course of hypertensive disease and osteoarthritis and can lead to the formation of osteoporosis, which is the basis for conducting substitution therapy.

Thus, according to the results of studies of foreign and domestic scientists, the problem of combining osteoarthritis with metabolic syndrome and arterial hypertension is important and relevant in world medicine. According to the literature, osteoarthritis is a pathology that is often combined with various diseases and syndromes. The leading role in the development and progression of OA in patients of middle and advanced age belongs to such components of the metabolic syndrome as hypertension and obesity.

Prof. IG Bereznyakov, and. V. Korzh. Osteoarthritis, arterial hypertension and obesity: the problem of comorbidity // International Medical Journal - №4 - 2012

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