AB0884 METABOLIC UNHEALTHY PHENOTYPE OF OBESITY IN PATIENTS WITH KNEE OSTEOARTHRITIS: THE EFFECTIVENESS OF ORLISTAT.

Abstract

Background: Obesity is an important socio-medical problem of mankind. Since the number of obese people in the world is increasing by about 1% per year, the immediate prospects do not look optimistic. One of the important risks of the development and progression of osteoarthritis (OA) is the metabolically unhealthy phenotype of obesity, which is accompanied by a violation of lipid and carbohydrate metabolism, a violation of cytokine regulation. An important step in the treatment of patients with obesity and OA of the knee joints is weight loss. Objectives: To evaluate the effectiveness of complex therapy of metabolic unhealthy phenotypes of obesity using orlistat (an intestinal lipase inhibitor) in the clinical manifestations of knee OA, dynamic markers of lipid and carbohydrate metabolism, dynamic CRP and leptin. Methods: The study included 50 female patients with knee OA Kellgren-Lawrence stage II-III and obesity (body mass index (BMI)>30kg/m2), aged 45-65yo. Group 1 (25 patients) was administered orlistat at 120 mg (1 capsule) 3 times a day for 6 month combined with low-calorie diet and therapeutic physical exercise. Group 2 (25 patients) was administered only life-modifying therapy for 6 month. The clinical parameters of the course of knee OA (WOMAC), an assessment of the quality of life (EQ-5D) were assessed at initially and after 6 months. Also initially and after 6 months a laboratory study of peripheral blood was performed glucose, HDL, LDL, TG, CRP, leptin, and the index of visceral obesity (IVO) was calculated. Results: Initially, all patients had signs of a metabolically unhealthy phenotype of obesity: waist circumference (WC) > 88cm, high IVO, dyslipidemia, arterial hypertension, hyperleptinemia. After 6 months of complex therapy of obesity using orlistat in patients of group 1, a significant decrease in body weight by 10.07% (p <0.05), a decrease in WC by 8 cm (p <0.05), a significantly significant decrease were achieved IVO (p <0.05), glucose (p <0.05). Analysis of cytokines showed a significant decrease in leptin (p <0.05) and CRP (p <0.05) in patients with a weight loss of more than 10%. The reduction in body weight in group 1 patients reduced pain by 52% (p <0.05), stiffness by 51% (p <0.05), improved joint functional failure by 51% (p <0.05) and improved quality life by 52% (p <0.05). In patients of group 2, against the background of non-drug therapy of obesity, body weight decreased by 0.84% (p> 0.05), slightly decreased WC (p> 0.05). Indicators of lipid metabolism, IVO, glucose, leptin remained unchanged (p> 0.05). The increase in CRP in patients of the 2nd group was determined by 24.54% (p <0.05). Conclusion: The results of our study demonstrate the effectiveness of the use of a comprehensive drug regimen for the treatment of metabolically unhealthy phenotype of obesity for the clinical manifestations of osteoarthritis of the knee joints; it contributes to the improvement of metabolic parameters: a decrease in WC, lipid and carbohydrate metabolism, CRP and leptin. Thus, the use of complex therapy using orlistat in patients with osteoarthritis and obesity leads to a decrease in the metabolic activity of adipose tissue, helps to reduce cardiometabolic risk and to improve the clinical course of osteoarthritis.