Pain in Women With Knee/Hip Osteoarthritis Associated With Adipose Tissue Dysfunction

woman suffering from pain in knees
Senior woman suffering from pain in knees at home. Holding her knee and massaging with hands, feeling exhausted, sitting on sofa in living room. Close-up. Medications and pills on table
Researchers assessed the association between adipose tissue dysfunction and osteoarthritis-related pain in women.

Adipose tissue dysfunction, as assessed by leptin/adiponectin ratio (LAR), and systemic inflammation, as determined by high levels of ultra-sensitive C-reactive protein (usCRP), are associated with pain level in women with osteoarthritis (OA), according to study results published in Seminars in Arthritis and Rheumatism.

Previous studies have emphasized the role of adipose tissue distribution and systemic inflammation in OA pathophysiology. Leptin and adiponectin are 2 major adipokines, with LAR being a reliable marker of adipose tissue dysfunction.

The objective of the current study was to determine the correlation between adipose tissue dysfunction and systemic inflammation and OA-related pain and functional limitation in women with knee and/or hip OA.

In the cross-sectional study, the researchers included 596 women (mean age, 63.0±12.0 years) with hip and/or knee OA from the Knee and Osteoarthritis Long-Term Assessment (KHOALA; Identifier: NCT00481338) cohort, a multiregional population-based cohort of patients aged 40 to 75 years with symptomatic lower limb OA. Pain was measured according to the visual analog scale (VAS) and pain subscores using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Osteoarthritis Knee and Hip Quality of Life (OAKHQOL).

Findings from multivariable analyses indicated an association between higher pain intensity and higher LAR, according to VAS pain (β=0.49; 95% CI, 0.24-0.73; P =.0001), OAKHQOL pain (β=-0.46; 95% CI, -0.69 to -0.22; P = .0002), and WOMAC pain (β=0.30; 95% CI, 0.12-0.49; P =.001). These correlations were also found for knee and hip OA populations separately.

Researchers also noted a correlation between pain intensity and usCRP level, according to VAS pain (β=0.27; 95% CI, 0.04-0.5; P =.02), OAKHQOL pain (β=-0.30; 95% CI, -0.55 to -0.06; P =.01), and Kellgren-Lawrence score.

Among the men included in the study (n=267), none of the investigated biomarkers were correlated with VAS pain, OAKHQOL pain, or WOMAC pain, according to multivariable analysis.

Researchers acknowledged several study limitations, including the cross-sectional design and the limited assessment of pain, with no available data on using pressure-pain threshold or the DN4 questionnaire.

“Such exploratory results, which need to be replicated in other cohorts, emphasize the role of adipose tissue dysfunction and of meta-inflammation in OA-related pain experience, especially in female population,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sellam J, Rat AC, Fellahi S, et al. Pain in women with knee and/or hip osteoarthritis is related to systemic inflammation and to adipose tissue dysfunction: Cross-sectional results of the KHOALA cohort. Semin Arthritis Rheum. 2020;51(1):129-136. doi:10.1016/j.semarthrit.2020.10.004