LAUSR

Background The long-term effect of comorbidities on progression of structural changes in osteoarthritis (OA) remains poorly understood. Patients with knee OA have been reported to be at increased risk of several comorbidities including cardiovascular diseases (CVD). Nevertheless, the impact of all comorbidities on structural progression and on arthroplasty, not only in knee but also in hip OA, should be further defined. Objectives The objective of our study was to explore the relationship between comorbidities and the progression of structural changes in symptomatic knee and/or hip OA patients over 5 years. Methods The KHOALA (Knee and Hip OsteoArthritis Long-term Assessment) cohort is a French prospective multicenter observational cohort that included 878 subjects, aged 40 to 75 years, with symptomatic hip and/or knee OA at baseline (Kellgren and Lawrence (KL) ≥2). The structural progression was defined by the increase of one point of KL (ΔKL ≥1) or incidence of total knee or hip replacement at 5 years. Various comorbidities were analyzed: cardiovascular diseases excluding hypertension (coronary artery disease, heart failure, stroke, lower limb arteriopathy), hypertension, diabetes, smoking, dyslipidemia, metabolic syndrome, osteoporosis, neurological (e.g. Parkinson’s disease, dementia), digestive (e.g. gastroesophageal reflux disease, ulcer), pulmonary (e.g. asthma, COPD), and psychiatric (depression, anxiety) diseases. Multivariate analysis was performed separately in hip and knee OA adjusted on age, sex and body mass index (BMI). Subjects with a BMI> 30 kg/m² were excluded from the analysis given the close relationship between obesity and the different comorbidities analyzed. Subjects with KL = 4 at the time of inclusion were also excluded from the analysis. Results Data from 631 non-obese subjects (BMI <30 kg/m²) were analyzed. At 5 years, cardiovascular diseases were significantly associated with the 5-year KL change in knee OA (OR = 2.6 [1.13-5.76], p=0.02) and with knee arthroplasty (OR = 3.4 [1.1-11.2], p=0.04). Such associations were not found at the hip. Other comorbidities had no significant impact on knee OA structural progression. No significant relationship was found between any type of comorbidities and hip OA structural progression. Conclusion This 5-year data analysis of the KHOALA cohort revealed a significant association between cardiovascular comorbidities and structural progression of knee OA in subjects without obesity (BMI <30 kg/m²). Other types of comorbidities do not appear to influence the structural prognosis of OA. These results argue for an integrated management of cardiovascular comorbidities in knee OA patients and highlight the differences between hip and knee OA. Disclosure of Interests Camille Roubille Grant/research support from: expanscience, Joel Coste: None declared, Jeremie Sellam: None declared, Anne-Christine Rat: None declared, Francis Guillemin Grant/research support from: Expanscience, Christian Roux: None declared