Approche phénotypique de l’arthrose : le cas de l’arthrose associée au syndrome métabolique

Abstract

Metabolic-associated osteoarthritis (OA) is a clinical phenotype defined by its risk factors (obesity, metabolic syndrome), and is characterized by a chronic low grade inflammation. Obesity is a major risk factor for knee OA but also for hand OA. Metabolic syndrome is also associated with an increased risk of OA. Indeed, there is a cumulative effect of metabolic diseases but also an independent role of each metabolic disease (diabetes, dyslipidemia or high blood pressure). Several mechanisms explain the increase cases of incident OA in obese subjects. Excess fat is responsible for an increase in mechanical stress. Adipose tissue is also responsible for the endocrine production of pro-inflammatory mediators (cytokines, adipokines, fatty acids, and reactive oxygen species) that have a harmful effect on joint tissues. More recently, the dysbiosis and sarcopenia of the obese subject have been implicated in this association. Osteoarthritis, whether associated or not with metabolic diseases, is associated with excess cardiovascular mortality, which can be explained by a sedentary lifestyle, but also by the common risk factors and by the low-grade inflammation associated with metabolic diseases. Finally, primary prevention and management of obesity and metabolic syndrome could slow the onset and progression of osteoarthritis.