ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 258

Underdiagnosis and Undertreatment Of Knee Osteoarthritis In The Obese Population: The Need For Physician Education and Advocacy

Janice Lin1, Ryan Flanagan2, Jay Bhatia2, Manish Parikh3, Christine Ren-Fielding3, Renata La Rocca Vieira4, Steven B. Abramson5 and Jonathan Samuels6, 1Medicine-rheumatology, NYU Langone Medical Center, New York, NY, 2Department of Rheumatology, NYU Langone Medical Center, New York, NY, 3Department of Surgery, NYU Langone Medical Center, New York, NY, 4Department of Radiology, NYU Langone Medical Center, New York, NY, 5Dept of Rheumatology/Medicine, NYU Langone Medical Center, New York, NY, 6Division of Rheumatology, Department of Medicine, NYU Langone Medical Center, New York, NY

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: obesity and osteoarthritis

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Title: Osteoarthritis - Clinical Aspects I: Risk Factors for and Sequelae of Osteoarthritis.

Session Type: Abstract Submissions (ACR)

Background/Purpose: Obesity is a modifiable risk factor of knee osteoarthritis (KOA) . While medical treatments for KOA can have a limited effect, an alternative strategy would target weight loss to reduce the arthritis burden. Supportive of other literature, we recently showed in a retrospective analysis that 51% of patients who underwent LapBand surgery reported complete improvement in KOA pain after 18 months. Therefore we began a prospective study to evaluate the prevalence of knee pain and KOA in the obese population, observe how knee pain is treated, and track how bariatric weight loss affects KOA-related pain and physical function.

Methods: We screened consecutive patients prior to bariatric surgery with the LapBand, sleeve gastrectomy, or gastric bypass. We enrolled patients (age≥21) with knee pain for ≥1 month and a visual analog scale (VAS) pain score ≥30mm, excluding lupus, inflammatory arthritis, or psoriasis. Treatment history for knee pain was recorded.  Baseline assessments included validated questionnaires: Western Ontario McMasters Universities Osteoarthritis Index (WOMAC), Assessment of Obesity-Related Comorbidities, and Knee Injury and Osteoarthritis Outcome Score. Those with radiographic KOA by the Kellgren-Lawrence (KL) grading scale >1 will repeat questionnaires post-surgery. 

Results: We evaluated 262 patients, with 136 reporting knee pain and 62 consenting for the study (88.7% female, mean BMI 44.5 kg/m2±8.3, range: 32.0-60.4, and mean age 44 years±10.3, range:22-70). 52% were scheduled for sleeve gastrectomy (mean BMI=43.0 kg/m2), 26% for Lapband (BMI=43.7), and 22% for gastric bypass (BMI=48.8). The mean VAS score was 65.4 (±19.1;range:30-100), WOMAC pain 265.1 (±101.8;range:13-466), WOMAC stiffness 99.1 (±59.2;range:0-187) and WOMAC physical function 917.1 (±427.9;range:0-1589). Baseline radiographs revealed that 96% had evidence of OA (70.6 % KL 2-4 and 25.4% KL1). Despite significant knee pain in this cohort, only 4.8% (3/62) had seen rheumatologists and 17.7% orthopedists — while 55% were treated by primary care and 22.5% had never discussed their knee pain treatment with a physician. Only 37% had taken x-rays previously to evaluate knee pain. Not surprisingly, the ACR OA treatment guidelines were not met in a majority of our cohort: Only 40.3% had been referred for physical therapy, 80.6% tried acetaminophen, 70.9% NSAIDs, 6.4% narcotics, 1.9% SSRI, 12.9% tramadol, 11.2% topical NSAIDs, 16.1% intra-articular steroids, and 3.2% viscosupplementation.

Conclusion: In this early phase of our prospective study of bariatric patients, we found that moderate radiographic KOA is common in obese patients with knee pain. In many cases, pain had been attributed to mechanical load from obesity without proper evaluation or treatment. Few patients were referred to rheumatologists, though would benefit from such evaluation and management. These data indicate that knee OA in obese patients is underdiagnosed and undertreated.  There is a need to educate primary care and bariatric providers that knee pain from OA and other pathology in obese patients should be diagnosed and treated appropriately to maximize their function and quality of life.


Disclosure:

J. Lin,
None;

R. Flanagan,
None;

J. Bhatia,
None;

M. Parikh,
None;

C. Ren-Fielding,
None;

R. La Rocca Vieira,
None;

S. B. Abramson,
None;

J. Samuels,
None.

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/underdiagnosis-and-undertreatment-of-knee-osteoarthritis-in-the-obese-population-the-need-for-physician-education-and-advocacy/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology