Even in 20s, weight raises arthritis risk

October 25, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer Medical Tribune News Service contributed to this article.

People who carry extra pounds of body fat while in their 20s greatly increase their risk of developing painful arthritis of the knees and hips decades later, a researcher from the Johns Hopkins School of Medicine said yesterday.

The bad news about body weight doesn't apply only to people who are obese. Those who are moderately overweight face a higher risk of developing arthritis, too, although the danger grows worse as weight increases.

Dr. Allan C. Gelber, a Hopkins rheumatologist, said few of the people in his study were seriously overweight. Nonetheless, a man who stands 5-foot-11 and weighs 190 pounds faces a 3 1/2 times greater chance of developing arthritis than does his 146-pound counterpart.

Doctors have long suspected that heavier people inflict extra wear and tear on their weight-bearing joints, causing cartilage to thin and in some cases disappear. This, however, was the first study to show that weight in a person's 20s can result in arthritis years later.

In effect, weight sets in motion a process of steady deterioration that may not be felt until the cartilage finally wears out in a person's 50s, 60s or beyond. It may take decades for the knee cartilage, initially as thick as the tip of an index finger, to grind away to nothing.

"If we are able to maintain our ideal body weight, there is a clear potential to decrease the burden of osteoarthritis in the knees and hips," said Dr. Gelber, who presented his findings yesterday at the annual meeting of the American College of Rheumatology in Minneapolis.

The findings may carry added significance in light of a report in July that showed the proportion of U.S. adults who are overweight suddenly jumped to one-third in the 1980s. In the preceding two decades, a quarter of American adults were overweight, according to the National Center for Health Statistics.

Dr. Gelber's study focused on osteoarthritis -- a painful condition caused by the loss of cartilage, the tough tissue that buffers bones meeting in a joint. Without cartilage, the joints become swollen, stiff and painful. The disease afflicts about one-third of all people over age 65.

The study capitalized on a data base of health information supplied by 1,178 men who graduated from the Johns Hopkins School of Medicine between 1948 and 1964. In the study, the students had physical examinations during their graduating years, and then annually filled out questionnaires about their health status.

At first, researchers used the graduates to track risk factors for hypertension and heart disease. But later, they realized that the graduates could also supply useful information on other diseases such as diabetes and arthritis. Called the Johns Hopkins Precursor Study, it focused predominantly on men because the student body was overwhelmingly male in those years.

The finding linking arthritis to weight was not without precedent.

In the mid-1970s, federal researchers who took X-rays of people in their 70s found that the heaviest were most likely to have osteoarthritis of the knee. But that created a "chicken and egg" dilemma: Did the extra weight trigger arthritis, or did the immobility of arthritis cause people to gain weight?

In the 1980s, researchers at Boston University got a clearer picture when they found that people who carried extra weight in their 30s were more likely to develop arthritis later on. Now, the Hopkins study suggests that the disease process can begin in a person's 20s.

Dr. Gelber cautioned that weight is probably not the only factor contributing to osteoarthritis. Other mechanical stresses -- including injuries and congenital joint abnormalities -- can also play a role.

Meanwhile, another study presented at the Minneapolis meeting showed that a combination of an anti-cancer drug and an agent used to prevent rejection of transplanted organs is showing promise for relieving the pain, swelling and stiffness of rheumatoid arthritis.

While the anti-cancer drug, methotrexate, has been used to control arthritic symptoms for years, it is not a cure and does not work well in all patients, said Dr. Peter Tugwell, a rheumatologist at the University of Ottawa in Canada and the study's lead investigator.

But the addition of low doses of the anti-rejection drug cyclosporine appears to make methotrexate more effective, with the combination therapy reducing joint inflammation, pain and disability significantly more than methotrexate alone, Dr. Tugwell reported.

In a study of almost 150 people, methotrexate alone resulted in a 30 percent improvement in pain, joint inflammation and quality of life, Dr. Tugwell said. When cyclosporine was added to the methotrexate therapy, about half of patients experienced a further 20 percent decrease in symptoms, he said.

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