Clinical Pearl: Metabolic Arthri Benefits

pearl-arthriBACKGROUND
For many years, the mechanical aspects of obesity were blamed for joint health concerns – and that makes sense. It’s obvious that there are mechanical aspects of obesity’s association with osteoarthritis (for example), because our knees, hips and low back have a lot of work to do, including weight bearing. However, the existence of biochemical mechanisms behind joint health concerns are made obvious by the fact that non-weight bearing joints, like fingers, also display both pain and high leptin levels.

metabolicarthribenefitsMECHANISM OF ACTION
First, it’s important to understand that the link between leptin levels and metabolism has been shown in various contexts; for example, researchers have found that synovial fluid (SF) leptin levels correlate significantly with both BMI and waist circumference.1

That correlation matters because we know that metabolic health can be affected by inflammation, that leptin correlates with metabolic parameters like waist circumference, and that leptin resistance is present with obesity. It stands to reason that a connection between leptin and inflammation may exist. In fact, studies have shown that leptin actually acts as a pro-inflammatory adipokine that upregulates proteolytic enzymes, working in synergy with other pro-inflammatory stimuli.2 This relationship results in ongoing degradation of synovial joint tissue and joint integrity.

PRACTICE IMPLICATION
By addressing joint health as a METABOLIC AND STRUCTURAL issue, the likelihood of clinically successful outcomes is far greater because of the direct connection between metabolism, hormones and joint health.

1-Gandhi R, Takahashi M, Syed K, Davey J, Mahomed N. Relationship between body habitus and joint leptin levels in a knee osteoarthritis
population. Journal of Orthopaedic Research. 2009:n/a-n/a. doi:10.1002/jor.21000.
2-Hui W, Litherland G, Elias M et al. Leptin produced by joint white adipose tissue induces cartilage degradation via upregulation and
activation of matrix metalloproteinases. Annals of the Rheumatic Diseases. 2011;71(3):455-462. doi:10.1136/annrheumdis-2011-200372.