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Diabetes-Associated Thigh Muscle Degeneration Mediates Knee Osteoarthritis–Related Outcomes: Results From a Longitudinal Cohort Study Publisher Pubmed



Mohajer B1 ; Moradi K2 ; Guermazi A3 ; Dolatshahi M2 ; Zikria B4 ; Najafzadeh N5 ; Kalyani RR6 ; Roemer FW3, 7 ; Berenbaum F8 ; Demehri S1
Authors
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Authors Affiliations
  1. 1. Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, 21287, MD, United States
  2. 2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Radiology, Boston University School of Medicine, Boston, MA, United States
  4. 4. Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  5. 5. Sharif University of Technology, Tehran, Iran
  6. 6. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  7. 7. Department of Radiology, Universitatsklinikum Erlangen & Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
  8. 8. Department of Rheumatology, Sorbonne University, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France

Source: European Radiology Published:2023


Abstract

Objectives: We examined the association between diabetes mellitus (DM) and longitudinal MRI biomarkers for thigh muscle degeneration in patients with knee osteoarthritis (KOA) and their mediatory role in worsening KOA-related symptoms. Methods: The Osteoarthritis Initiative (OAI) participants with radiographic KOA (Kellgren-Lawrence grade ≥ 2) were included. Thighs and corresponding knees of KOA patients with versus without self-reported DM were matched for potential confounders using propensity score (PS) matching. We developed and used a validated deep learning method for longitudinal thigh segmentation. We assessed the association of DM with 4-year longitudinal muscle degeneration in biomarkers of muscle cross-sectional area (CSA) and contractile percentage (non-fat CSA/total CSA). We further investigated whether DM is associated with 9-year risk of KOA radiographic progression, knee replacement (KR), and symptoms worsening. Finally, we evaluated whether the DM–KOA worsening association is mediated through preceding muscle degeneration. Results: After PS matching, 698 thighs/knees were included (185:513 with:without DM; average ± SD age:64 ± 8-years; female/male:1.4). Baseline DM was associated with a decreased contractile percent of total thigh muscles and quadriceps (mean difference, 95%CI −0.16%/year, −0.25 to −0.07, and −0.21%/year, −0.33 to −0.08). DM was also associated with an increased risk of worsening KOA-related symptoms (hazard ratio, 95%CI 1.70, 1.18–2.46) but not radiographic progression or KR. The decrease in quadriceps contractile percent partially mediated the increased risk of symptoms worsening in patients with DM. Conclusions: Baseline DM is associated with thigh muscle degeneration and KOA-related symptoms worsening. As a potentially modifiable risk factor, DM-associated longitudinal thigh muscle degeneration may partially mediate the symptoms worsening in patients with DM and coexisting KOA. Key Points: • Diabetes mellitus (DM) is associated with worsening knee osteoarthritis (KOA)-related symptoms. • As a potentially modifiable factor, DM-associated thigh muscle (quadriceps) degeneration partially mediates the worsening of KOA-related symptoms. © 2022, The Author(s), under exclusive licence to European Society of Radiology.
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