Increased risk of osteoarthritis in patients with atopic disease What is already known about this topic? Osteoarthritis (OA) is a common chronic disabling disease for which there are few effective treatments. Growing evidence suggests that activation of mast cells and allergic pathways may play a key role in the pathogenesis of OA. If so, the occurrence of OA may increase in patients with atopic diseases; however, this currently remains unknown. What does this study contribute? In this propensity score-matched study using administrative health claims data, we found a significantly higher incidence of OA in patients with asthma or atopic dermatitis or the combination of asthma and atopic dermatitis. These results were confirmed in an academic institutional cohort. How it affects clinical practice This study demonstrates an association between atopic disease and the development of OA; Patients may benefit from using treatments that inhibit mast cells and allergic cytokines to treat or prevent OA. |
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People with atopic (allergic) diseases such as asthma or eczema may be at increased risk of osteoarthritis, a painful and often disabling joint condition, finds research published in the Annals of the Rheumatic Diseases .
Medications used to dampen the physiological indications of allergic reactions in the body may help decrease this risk, researchers suggest.
Osteoarthritis is the most common form of arthritis . But despite the high prevalence, substantial costs and debilitating impact of the disease, there is still no effective cure. Treatment focuses mainly on symptom control.
Growing evidence suggests that the activation of a type of white blood cell called mast cells and inflammatory chemicals (cytokines) involved in allergic reactions may play a key role in the development of osteoarthritis. But it is not clear whether people with allergic asthma or eczema may be at higher risk of the condition.
To try to find out, researchers relied on claims submitted to a nationwide US insurance database (Optum CDM) between January 2003 and June 2019, and electronic health records from the Research Repository from Stanford (STARR) for the period 2010 to 2020.
In total, 117,346 people with allergic asthma or eczema (mean age 52; 60% women) and 1,247,196 people without atopic disease (mean age 50; 48% women) were identified in the insurance claims database.
About 109,899 people with atopic disease were matched for age, sex, race/ethnicity, education level, underlying conditions, length of follow-up period, and outpatient visits to 109,899 people without allergic asthma or eczema.
The risk of developing osteoarthritis over an average follow-up period of 8 years was 58% higher in those with allergic asthma or eczema than among those without atopic disease: in other words, there would be 27 new cases versus 19 new cases if 100 people with and without atopic disease were monitored for 10 years each.
This trend was even more noticeable among the 4,325 people with allergic asthma and eczema: They were twice as likely to develop osteoarthritis as those without atopic disease.
Similarly, the 11,820 people with allergic asthma alone were 83% more likely to develop osteoarthritis over 8 years than those with chronic obstructive pulmonary disease (COPD), a lung disease that does not involve allergic pathways.
The researchers then compared the risk of osteoarthritis between people with and without asthma/allergic eczema from STARR health records to see if they could obtain similar results.
STARR participants comprised 114,427 patients, including 43,728 with allergic asthma or eczema and 70,699 without a history of atopic disease. This data set also included information on weight (BMI), a significant risk factor for osteoarthritis.
After adjusting for BMI, the odds of developing osteoarthritis were 42% higher among people with allergic asthma or eczema, and 19% higher among those with both.
The researchers acknowledge several limitations to their findings, including reliance on insurance claims data for part of the study: these did not include information on potentially influential factors, such as BMI, previous joint injuries, or physical activity levels.
The fact that the observed associations were weaker among STARR participants, for whom information on BMI was available, suggests that other factors could be involved, they note.
And there was no information available on the severity of atopic disease or osteoarthritis, or the use of common over-the-counter remedies, all of which may have influenced the findings.
However, the researchers conclude: “Patients with atopic disease have a higher risk of developing [osteoarthritis] compared to the general population. The association between atopic disease and [osteoarthritis] is supported by recent observations that mast cells and type II cytokines may play an important role in [their] pathogenesis in general, not only in patients with atopic disease.”
They add: “Our findings provide further support for the concept that allergic pathways may contribute to the development of [osteoarthritis]. If this is true, non-atopic patients may also benefit from using treatments that inhibit mast cells and allergic cytokines to treat or prevent [osteoarthritis].”
Conclusions In conclusion, patients with atopic disease have a higher risk of developing OA compared to the general population.The association between atopic disease and OA is supported by recent observations that mast cells and type II cytokines may play important roles in the pathogenesis of OA in general, not only in patients with atopic disease. Our findings provide further support for the concept that allergic pathways may contribute to the development of OA. If this is true, non-atopic patients may also benefit from using treatments that inhibit mast cells and allergic cytokines to treat or prevent OA. |
