Osteoarthritis, arterial hypertension and obesity: the problem of comorbidity

The concept of comorbidity, the simultaneous damage of two or more organs and body systems, has been widely covered in the literature of recent years. Comorbidity can occur as syntropy, the damage 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: diseases or disorders that are comorbid to a specific disease are understood as those disorders that occur most frequently with this disease and have some common etiological or pathogenetic mechanisms with it.

Recently, the attention of scientists has been attracted by the problem of combination of different joint diseases in patients with metabolic and cardiovascular disorders. In patients with osteoarthrosis (OA) in combination with metabolic syndrome (MS), significant lipid metabolism disorders and increased oxidative stress activity were found, which contributed to the degradation of connective tissue structures of the body. Patients with osteoarthrosis have an increased risk of developing cardiovascular pathologies, which increases during treatment with non-steroidal anti-inflammatory drugs in the presence of other factors - age-related changes, obesity and arterial hypertension (AH). For example, according to I. O. Romanova, 62% of patients with osteoarthrosis were found to have AH and an increase in the blood level of C-reactive protein, the degree of which depends on the risk factors for the development of cardiovascular disorders, pain syndrome and the stage of the disease. Also, in patients suffering from osteoarthritis, damage to the endothelium and disruption of its functions were found - 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 research by American scientists, osteoarthritis is one of the main problems of the health care system, primarily due to its connection with cardiovascular diseases, which are becoming one of the main causes of death of patients. Today, there is much evidence that osteoarthritis is not just a disease associated with disorders of the morphofunctional state of the joints, but a metabolic disorder in which metabolic disorders develop that contribute to the emergence and progression of a systemic pathological process. Thus, the development of OA is associated not only with obesity and arterial hypertension, but also with other cardiovascular risk factors - diabetes mellitus, insulin resistance and dyslipidemia. Scientists from the USA studied the prevalence of metabolic syndrome in patients with osteoarthritis in connection with metabolic disorders and the development of systemic inflammation in 7,714 patients. 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: arterial hypertension (75% vs. 38%), abdominal obesity (63% vs. 38%), hyperglycemia (30% vs. 13%), elevated triglycerides (47% vs. 32%) and low low-density lipoproteins (44% vs. 38%). MS was most common in patients with osteoarthritis, regardless of gender and race. The relationship between osteoarthritis and metabolic syndrome was noted in young patients and decreased with age. Scientists from the University of California conducted a study of obesity and cardiovascular risk in patients with osteoarthritis during 2002-2006. 6,299 adult patients under 35 years of age were examined. Osteoarthritis was detected in 16.5% of women and 11.5% of men, with the number of patients increasing with age and being higher among women. The presence of pain syndrome in osteoarthritis was associated with the degree of obesity, hypertension - with smoking of patients. In men, no connection was found between diabetes mellitus and 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.

Body mass index (BMI) is of great importance in assessing the clinical condition of patients with osteoarthritis combined with arterial hypertension and obesity. It is known that obesity predominantly develops osteoarthritis of the knee joints, to a lesser extent - hip joints. A relationship was also established between BMI, the number of affected joints and radiographic progression of osteoarthritis. Excess body weight (BMI> 25) was associated with an increased incidence of osteoarthritis of the knee joints, but not the hip joints. With a BMI greater than 27.5, radiographic progression of only osteoarthritis of the knee joints was noted. Evidence of the effect of obesity on the development of coxarthrosis is ambiguous: some authors confirm a possible association of these pathologies, while others do not. In a study of 298 patients with osteoarthritis of the knee and hip joints, BMI was calculated, waist and hip circumference were measured, and the relationship of these indicators with 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. These patients showed an obvious increase in the prevalence 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 was found that the prevalence of OA increases with age. Ninety-one patients were examined (mean age 59.3 years, 91.4% were women). Metabolic syndrome was diagnosed in 54.9% of patients, hypertension - in 75.8%, dyslipidemia - in 52.6% and obesity - in 57.1% of patients. Depression was observed in 61.3% of patients with OA. Depression, metabolic syndrome or its individual components affect the intensity of pain syndrome and the physical condition of patients, which indicates the need to study and treat concomitant diseases in patients with osteoarthritis.

Swedish scientists conducted a study of the relationship between the level of C-reactive protein, metabolic syndrome and the incidence of osteoarthritis of the knee and hip joints: the increased incidence of osteoarthritis of the knee joints in patients with MS in most cases was due to increased BMI, and the level of C-reactive protein in the blood was not associated with the development of osteoarthritis.

Norwegian scientists studied a group of 1854 patients with combined pathology - obesity and osteoarthrosis. The age of the patients ranged from 24 to 76 years, obesity was defined by a BMI above 30.0. As a result, high BMI was significantly associated with gonarthrosis, not coxarthrosis.

In scientific studies by Italian scientists, clinical manifestations of concomitant diseases in osteoarthritis were determined. A total of 25,589 patients were examined, of which 69% were women and 31% were men. The most common concomitant pathologies in osteoarthritis were hypertension (53%), obesity (22%), osteoporosis (21%), type 2 diabetes mellitus (15%) and chronic obstructive pulmonary disease (13%). Pain syndrome in osteoarthritis was more pronounced in women than in men. Thus, the results of this study emphasize the high frequency 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 diagnostics and treatment of osteoarthrosis combined with other pathologies is considered and developed by specialists of both therapeutic and orthopedic profiles. According to V. A. Filippenko et al., osteoarthrosis is accompanied by 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 disorders in the hemostasis system, which are manifested by an increase in the concentration of fibrinogen, soluble fibrin-monomer complexes and an increase in fibrinolytic activity in the blood plasma. When examining patients with osteoarthrosis with obesity and hypertension, in addition to an increase in the concentration of cholesterol and beta-lipoproteins in the blood, an increase in the level of biochemical indicators of the state of connective tissue (glycoproteins, chondroitin sulfates) was observed, which indicates a high activity of the systemic inflammatory process in the body, enhanced by concomitant diseases.

According to I. E. Koroshina, MS was determined in 82.3% of the examined patients with osteoarthrosis. In osteoarthrosis, patients with metabolic syndrome often developed damage to the cardiovascular system, gastrointestinal tract, kidneys and thyroid gland, and also developed diabetes mellitus, obesity and concomitant diseases. Thus, metabolic disorders in OA may indicate their participation in the development and progression of the disease.

Based on the results of the studies by I. V. Soldatenko et al., clinical features, heart rate variability, and the effectiveness of control of hypertension comorbid with OA were established depending on the types of orthostatic reactions and daily blood pressure profiles. Hypertension combined with OA did not affect the initial indicators of heart rate variability, but at the same time impaired reactions to orthostasis. Among the set of clinical signs and heart rate variability indicators studied, the statistically significant criteria for the effectiveness of blood pressure control in patients with hypertension comorbid with osteoarthritis were the age of the patients and the ratio of the sympathovagal balance.

According to L. M. Pasiishvili, patients with hypertension were found to have hypocalcemia and hypercalciuria, which significantly increase with the addition of osteoarthrosis. The identified changes can be considered one of the mechanisms for the development and progression of these pathologies. These changes are an unfavorable factor in the combined course of hypertension and osteoarthrosis and can lead to the formation of osteoporosis, which is the basis for replacement therapy.

Thus, according to the results of research by foreign and domestic scientists, the problem of the combination of osteoarthrosis with metabolic syndrome and arterial hypertension is important and relevant in world medicine. According to literary data, osteoarthrosis is a pathology that is often combined with various diseases and syndromes. The leading role in the development and progression of OA in middle-aged and elderly patients belongs to such components of the metabolic syndrome as arterial hypertension and obesity.

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

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