How to treat osteoarthritis in obese patients?

The close association between osteoarthritis (OA) and obesity is well established. The concomitant increasing prevalence of the two diseases has major health, social and economic consequences. However, to date there is no specific recommendation for the medical management of obese patients with OA. Current recommendations only specify that obese patients must lose weight and practice regular physical activity in addition to the usual care. OA symptoms improvement is clinically relevant from a weight loss > 5% of the body weight. Weight loss improves not only OA symptoms but also metabolic abnormalities and cardiovascular risk factors commonly altered in subjects with obesity. In case of morbid obesity, bariatric surgery may be the only one alternative for pain relief. non-steroidal anti-inflammatory drugs and corticosteroids must be avoided in patients with metabolic syndrome. In such patients symptomatic slow acting drugs for OA (i.e. glucosamine, chondroitin...) and some anti-oxidant drugs (i.e. curcumin...) may be helpful thanks to their excellent benefit/risk ratio and their mode of action which may have a positive impact on both OA and metabolic disorders. Patients and physicians should know that intra-articular treatments for OA (corticosteroids and hyaluronic acid) have a lower success rate in obese patients than in patients with normal BMI. Spa therapy contributes to relief pain, favour weight-loss and reduce metabolic abnormalities with a favourable risk/benefit balance.