Association Between Metabolic Syndrome and Clinical Severity of Knee Osteoarthritis: A Cross-Sectional Study at The University of Lahore Teaching Hospital, Lahore

Abstract

Background: Knee osteoarthritis is a major cause of chronic pain, disability, and reduced quality of life among older adults worldwide. Increasing evidence suggests that metabolic syndrome contributes to osteoarthritis progression through systemic inflammatory and metabolic mechanisms in addition to mechanical joint stress. However, limited regional data are available regarding the relationship between metabolic syndrome and clinical severity of knee osteoarthritis in Pakistani populations. Objective: To evaluate the association between metabolic syndrome and clinical severity of knee osteoarthritis among patients presenting to The University of Lahore Teaching Hospital, Lahore. Methods: This cross-sectional observational study included 186 participants comprising 93 patients with knee osteoarthritis and 93 controls. Demographic, anthropometric, metabolic, radiographic, and functional data were collected using standardized clinical assessment tools. Metabolic syndrome components including obesity, hypertension, diabetes mellitus or hyperglycemia, dyslipidemia, and central obesity were evaluated. Clinical severity was assessed using WOMAC pain and functional scores along with radiographic severity grading. Multivariable logistic regression analysis was performed to identify predictors of poor clinical outcome. Results: Metabolic syndrome was identified in 52.2% of participants and demonstrated a strong independent association with poor clinical outcome (OR 3.42, 95% CI: 1.78–6.58; p<0.001). Central obesity (OR 2.91, 95% CI: 1.52–5.57; p=0.001), hypertension (OR 1.88, 95% CI: 1.01–3.51; p=0.047), and BMI ≥30 kg/m² (OR 2.36, 95% CI: 1.13–4.94; p=0.022) were also significantly associated with adverse outcomes. The mean WOMAC pain, function, and total scores were 9.8 ± 4.6, 31.5 ± 13.2, and 45.7 ± 18.9, respectively. Conclusion: Metabolic syndrome and obesity-related metabolic abnormalities were significantly associated with increased clinical severity, pain burden, and functional impairment among patients with knee osteoarthritis. Early identification and multidisciplinary management of metabolic risk factors may improve long-term outcomes and reduce disability in affected individuals.