Rapid Progression of Knee Pain and Osteoarthritis Biomarkers Greatest for Patients with Combined Obesity and Depression: Data from the Osteoarthritis Initiative

Abstract

Objective: To compare the progression of biochemical biomarkers of osteoarthritis (OA), knee pain, and function between nonobese patients (NON), obese patients without depression (OBESE), and obese patients with comorbid depression (O + D).

Design: Utilizing the FNIH OA Biomarkers Consortium dataset, we categorized knee OA patients into NON, OBESE, and O + D groups based on body mass index and Center for Epidemiological Studies-Depression (CES-D) scores. Subjective symptoms (Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QOL), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores, and the Short Form-12 (SF-12) Physical Component Score [PCS]) and objective measures of cartilage degradation and bone remodeling (urinary CTXII and CTXIα) were compared among groups at baseline and 2-year follow-up.

Results: Of the 600 patients, 282 (47%) were NON, 285 (47.5%) OBESE, and 33 (5.5%) O + D. The O + D group had significantly worse pain and function both at baseline and 2-year follow-up (P < 0.001 for all comparisons) as evidenced by self-reported measures on KOOS QOL, WOMAC Pain, WOMAC Physical Function, and SF-12 PCS. The O + D group also demonstrated significant increases in CTXII (P = 0.01) and CTXIα (P = 0.005), whereas the NON and OBESE groups did not.

Conclusions: The combination of inferior knee pain, physical function, and significantly greater increases in biomarkers of cartilage degradation and bony remodelling suggest a more rapid progression for obese OA patients with comorbid depression. The link between systemic disease, inflammatory burden, and progressive cartilage degradation is in line with increasing concerns about a degenerative synovial environment in early osteoarthritic knees that progress to treatment failure with biologic restoration procedures.

Trial registration: ClinicalTrials.gov NCT00080171.

Keywords: biomarker; depression; knee; obesity; osteoarthritis; pain.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The OAI is a public-private partnership composed of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health (NIH), a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This article was prepared using an OAI public use dataset and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. Data provided from the FNIH OA Biomarkers Consortium Project are made possible through grants and direct or in-kind contributions by: AbbVie; Amgen; Arthritis Foundation; Artialis; Bioiberica; BioVendor; DePuy; Flexion Therapeutics; GSK; IBEX; IDS; Merck Serono; Quidel; Rottapharm | Madaus; Sanofi; Stryker; the Pivotal OAI MRI Analyses (POMA) study, NIH HHSN2682010000 21C; and the Osteoarthritis Research Society International.

Figures

Figure 1.

Significantly greater increases in CTXII (mean ± standard error) were noted between baseline to 2-year follow-up for the group of patients with combined obesity and depression (O + D). Values normalized to urinary creatinine concentration and expressed as ng/mmol Cr.

Figure 2.

Significantly greater increases CTXIα (mean ± standard error) were noted between baseline to 2-year follow-up for patients with combined obesity and depression (O + D). Values normalized to urinary creatinine concentration and expressed as µg/mmol Cr.