Which Comes First: Obesity Or Arthritis?

A woman wearing a hospital gown smiling while weighing herself.(BlackDoctor.org) — Obesity-related diseases are becoming a quickly increasing problem in the Western world, the result of an extreme obesity epidemic that now rivals hunger-related health problems as a primary cause of worldwide morbidity and mortality. Many common diseases have been linked to obesity, including osteoarthritis (OA). Although OA is the most prevalent joint disorder, obesity is also known to be a factor in developing other musculoskeletal conditions that can result in joint pain and disability.

OA is a common condition, affecting 70% of senior citizens who are older than 65. This accounts for a staggering 27 million residents of the United States—12.1% of adult Americans. The world’s population is aging and becoming overweight at a fast pace—two of the major risk factors for developing OA. The social and economic burden resulting from the prevalence of OA is distressingly high.

The symptom most strongly associated with OA is joint pain, which is the result of a loss of articular cartilage. Pain is most often experienced in the hip, knee, and hand joints. Those still in the first stages of OA only have pain when they use the affected joint, but as the disease progresses the pain becomes more constant. Eventually sufferers experience pain even when their joints are resting and when they are asleep.

Treatment: Arthritis & Obesity

Treatments for OA are focused on pain relief, and there are both surgical and non-surgical options available. Surgery to treat OA is a last resort for those whose symptoms are severe and resistant to other forms of treatment. For most OA sufferers, symptoms can be controlled through the use of medication, proper nutrition, acupuncture, and changes in lifestyle.

A pharmacological approach to OA therapy is common, achieving pain relief through the use of non-steroidal anti-inflammatories (Advil, Aleve, Orudis) and analgesics (Tylenol). However, a number of people experience side effects when using these medications, most frequently gastrointestinal problems.

Obesity and Arthritis : The Link

Numerous research studies have shown that there is a positive relationship between weight and OA. Results of population-based studies have been consistent in finding that overweight people are at an increased risk of developing OA when compared to people from the same population who are not overweight.

A large Australian study found that overweight adults are at double the risk for being diagnosed with OA than adults of a normal weight. This study of 7500 people found the relationship between BMI (a measure of excess weight) and obesity to hold even after adjusting for socioeconomic status, age, and sex.

Which Comes First: Obesity or OA?

Demonstrating a relationship between obesity and OA isn’t enough to prove that excess weight is a cause of OA. For example, an alternative explanation could be that the significant knee pain experienced by OA sufferers reduces their amount of physical activity and leads to weight gain.

This question of causality has been addressed by several studies. The Framingham Heart Study followed up with 1420 subjects over the course of 36 years. The results showed that those who were overweight when the study began, at age 37, were at an increased risk of developing OA by the end of the study, when they were 73. Since knee OA was extremely rare at the age of 37, this indicates that obesity was the causative factor rather than OA.

Excessive Scarring: Prevention & Management


woman holding mask(BlackDoctor.org) — Excessive scarring is the result of many factors, including extensive trauma to the tissues around a wound, the length of time that the wound is open before it heals, the location of the wound on the body, as well as skin color. People with higher quantities of skin pigmentation from melanin tend to make thicker and darker scars.

Hypertrophic Scars

When more than enough scar tissue is formed following surgery or trauma, the scar is considered to be hypertrophic. Hypertrophic scarring is characterized by rapid growth in the first several month, accompanied by itching and skin darkening from excess inflammation. These types of scars generally shrink over time, but can leave unsightly skin deformities.

Keloid Scars

Although hypertrophic scars may be very dark and thick, they should not be confused with keloid scars. Keloid scars can be thought of as a severe form of scarring in which large scars form even after minor cuts or scratches. Keloid scars are more persistent, don’t fade, are constantly painful, itchy and have a tendency to reoccur after surgical excision.

Despite release of several new therapies for scar management that offer hope to patients with excessive scarring, the first consideration in scar management is prevention. Method of care during the management of the open wound is influential, so providing a healthy environment for the wound to heal is essential. Once the wound is closed, treatment can begin to minimize scarring, itching and excess pigmentation.

One very basic and important management approach is limiting inflammation, which is paramount to reducing the potential for excessive scarring. It is important not to scratch or rub scars. Do not use alcohol-based therapies that irritate the incision.

As far as treating an existing scar, there are many different types of treatments available. While steroids are traditional therapy for scar treatment, their adverse side effects prevent routine use on all cuts or scratches. However, non-steroidal, anti-inflammatory drugs (NSAIDS) have recently been found to provide an effective option in scar management. In particular, they reduce troublesome symptoms such as excessive itching (pruritus) and pigmentation.

Regardless of which treatment option you choose, always consult with either a primary care physician or a dermatologist to ensure optimal healing and prevention of further damage and infection.