骨关节炎:减重可减少膝软骨负担


  【24drs.com】长久以来,医师一直建议减重以缓解膝盖骨关节炎(osteoarthritis,OA)的疼痛与不适,现在,有证据支持这项医疗建言。
  
  在一篇有112名肥胖成人的研究中,澳洲研究者发现,减重和胫骨内侧软骨量流失较少以及改善膝盖功能有关,若体重增加则是有反效果。这些研究发现在线登载于2月11日风湿性疾病学志。
  
  澳洲墨尔本Monash大学暨Alfred医院的Andrew J. Teichtahl医师等人写道,这些结果认为,对于肥胖病人,体重变化对疾病相关之膝关节构造与功能有所影响;减重是帮助肥胖者减少他们的膝盖症状和有害之结构性变化的主要对策,另外,肥胖者也应避免体重增加。
  
  作者们指出,虽然最近的系统性回顾显示减重手术或非手术之减重计画可改善膝关节炎,但是还没有确切证据。
  
  资深作者Alfred医院肌肉关节主任Flavia Cicuttini博士表示,我们知道,胫骨软骨越少时,膝盖越痛,胫骨软骨流失表示将来可能需要置换膝关节。
  
  她表示,骨关节炎是整个膝盖的疾病,而关节软骨流失是疾病严重度和恶化的讯号。我们知道,流失软骨和膝盖骨关节炎的严重度有关,可用X光测量,X光检查结果越差表示胫骨软骨越少。我们分析膝盖软骨,特别是胫骨软骨,因为可让我们以一种比X光更敏感的方式检视膝盖状态。
  
  为了解体重变化对膝关节的影响,Teichtahl博士等人从减重计画和社区其它来源招募112名肥胖成人(身体质量指数≧30 kg/m 2),检视胫骨软骨和膝盖症状的变化(平均追踪2.3年),采用「West Ontario and McMaster Osteoarthritis Index (WOMAC)」进行评分。
  
  他们发现,体重相较于开始时的变化百分比和WOMAC的各项指标有关,包括疼痛(β功能,-1.8 mm;P < .01)、僵硬(β,-1.6 mm;P < .01)与功能(β,-6.9 mm;P < .01 )。
  
  这关联属于线性关系,体重减少每1%与胫骨内侧软骨容积流失减少1.2 mm 3有关,相对的,体重增加每1%和流失量增加1.2 mm 3有关。
  
  校正年纪、性别、身体质量指数、各次扫描之间的时间、开始时的软骨量之后,多变项分析显示依旧有此关联。
  
  作者们指出,虽然研究只有包括肥胖成人,各种体型的人应该都存在有体重改变和膝盖骨关节炎之间的关联。
  
  Cicuttini博士表示,虽然有证据认为肥胖是髌骨股骨关节炎的风险因素,他们并未观察到体重减少和髌骨软骨量的显著影响。
  
  她指出,这可能是因为部位空间较小,我们需要更多研究对象和更长的研究期间,以确认是否有效,而我们的研究量体还不足以确认效果。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7053&x_classno=0&x_chkdelpoint=Y
  

Osteoarthritis: Weight Loss Takes a Load Off Knee Cartilage

By Neil Osterweil
Medscape Medical News

Clinicians have long recommended losing weight to help ease the pain and discomfort of knee osteoarthritis (OA), and now there is evidence to back up that bit of medical wisdom.

In a study of 112 obese adults, Australian investigators found that weight loss was associated with a lower amount of cartilage volume loss in the medial tibia and an improvement in knee symptoms, whereas further weight gain had the opposite effect. The findings were published online February 11 in the Annals of Rheumatic Diseases.

"These results suggest that in obese people, weight change has a potentially disease modifying effect on both knee joint structure and symptoms. While weight loss is an important primary management strategy in obese individuals to reduce their knee symptoms and deleterious structural changes, avoidance of further weight gain must also be a management goal in obese individuals," write Andrew J. Teichtahl, MD, from Monash University and Alfred Hospital in Melbourne, Australia, and colleagues.

The authors note that although recent systematic reviews have shown improvements in knee OA after bariatric surgery or a nonsurgical weight loss program, hard evidence for the effect has been hard to come by.

"We know that the less tibial cartilage there is, the more knee pain there is, and loss of tibial cartilage predicts the need for knee replacement," senior author Flavia Cicuttini, MD, PhD, head of the musculoskeletal unit at Alfred Hospital, told Medscape Medical News.

"Although OA is a disease of the whole joint, articular cartilage loss is the hallmark of disease severity and progression. We know that loss of cartilage correlates with the severity of knee OA as measured using X-ray, so the worse the X-ray the less tibial cartilage there is. We use knee cartilage, and specifically tibial cartilage, because it allows us to examine the state of the joint in a very sensitive way — far more sensitive than X-ray," she said.

To see how weight change may affect the knee joint, Dr. Teichtahl and colleagues recruited 112 obese adults (body mass index ? 30 kg/m 2) from weight loss programs and other sources in the community. They looked at change over time (mean follow-up, 2.3 years) in tibial cartilage volume and knee symptoms, as scored by the West Ontario and McMaster Osteoarthritis Index (WOMAC).

They found a relationship between percentage weight change from baseline and change in all subscales of the WOMAC index, including pain (β function, ?1.8 mm; P < .01), stiffness (β, ?1.6 mm; P < .01), and function (β, ?6.9 mm; P < .01 ).

The relationship appeared to be linear, with every 1% of weight loss associated with a 1.2 mm 3 decrease in the loss of medial tibial cartilage volume. Conversely, every 1% gain in weight was associated with 1.2 mm 3 increase in loss of volume.

The association held up in multivariate analysis adjusted for age, sex, body mass index, time between scans, and baseline cartilage volume.

The authors note that although the study included only obese adults, the relationship between weight change and knee OA is likely to be seen in people with various body types.

Dr. Cicuttini said that although there is evidence to suggest that obesity is a risk factor for patellofemoral OA, they did not see a significant effect of weight loss on patellar cartilage volume.

"It may be that if the effect is smaller in that compartment, we would need larger numbers and a longer time period to show an effect if there is one, and our study was not large enough to show smaller effects," she noted.

The study was supported by Monash University. The authors have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online February 11, 2014.

    
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