OP0178 CARDIOVASCULAR COMORBIDITIES HAVE A DELETERIOUS IMPACT ON KNEE OSTEOARTHRITIS PROGNOSIS AT 5 YEARS: DATA FROM THE PROSPECTIVE KHOALA COHORT

Abstract

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 arterio-pathy), 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 <30kg/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.