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September 2019 -
Volume 17, Issue 9

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From the Editor



Original Contribution

Assessment of patient safety culture in tertiary health care settings in Taif City, Saudi Arabia
Dalia El-Sayed Desouky , Atheer Alraqi , Rabeah Alsofyani , Najla Alghamdi
DOI: 10.5742MEWFM.2019.93673

The Development of a Primary Health Care system in the State of Qatar
Asan Ali Qasim Al Nyazee, Sarab K. Abedalrahman, Zeena N. Abdulrahman, Islam A.R. Zadawy
DOI: 10.5742MEWFM.2019.93667

Hypoglycemia: Its effect on patients with diabetes
Bilal Ahmed, Muhammed Naeem Khan
DOI: 10.5742MEWFM.2019.93675

Extracorporeal shock wave lithotripsy and ureterorenoscopy procedures of ureteric stone disease inpatients with a solitary kidney in Aden
Ali Ahmed Salem Hatroom
DOI: 10.5742MEWFM.2019.93681

Population and Community Studies

Symptomatic Knee Osteoarthritis and Dyslipidemia. A study from Kurdistan of Iraq
Asso Amin, Raof Merza, Mohammed J. Baban, Hawar Khan, Khalid A. Hama-ghareeb, Mohammed IM Gubari, Soran Noori, Saman Sadeq, Alan Saeed
DOI: 10.5742MEWFM.2019.93682

Smoking-induced endothelial damage may increase plasma triglycerides
Mehmet Rami Helvaci, Abdulrazak Abyad, Lesley Pocock
DOI: 10.5742MEWFM.2019.93676


Middle East Quality Improvement Program

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE


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Lesley Pocock
medi+WORLD International

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September 2019 - Volume 17, Issue 9

Symptomatic Knee Osteoarthritis and Dyslipidemia.
A study from Kurdistan of Iraq

Asso Amin (1)
Raof Merza
Mohammed J. Baban
Hawar Khan
Khalid A. Hama-ghareeb
Mohammed IM Gubari
Soran Noori
Saman Sadeq
Alan Saeed

(1) Department of Medicine, College of Medicine, Ministry of Higher Education, Kurdistan Regional Government, Iraq.
(2) Department of Rheumatology, Sulaimany General Medical Teaching Hospital, Sulaimany, Iraq.
(3) Department of Orthopedic, Sulaimany Surgical Teaching Hospital, Sulaimany, Iraq.
(4) Department of Family Physician, PHCC-Qatar, Doha, Qatar.

Dr Asso Amin,
Department of Medicine, College of Medicine, Ministry of Higher Education,
Kurdistan Regional Government, Iraq.

Received: July 2019; Accepted: August 2019; Published: September 1, 2019. Citation: Asso Amin. et al. Symptomatic Knee Osteoarthritis and Dyslipidemia. A study from Kurdistan of Iraq. World Family Medicine. 2019; 17(9): 30-35. DOI: 10.5742MEWFM.2019.93682


As a complex multifactorial condition, knee osteoarthritis has been considered as a leading cause of disabilities. Dyslipidemia is a metabolic component that can probably play a role in knee osteoarthritis development and comorbidities; however, this relationship is still debated. The present study was carried out in order to figure out the prevalence of dyslipidemia among knee osteoarthritis patients and to compare their abnormal serum lipid components with non-exposed individuals.

Patients and methods: A total of 60 patients with knee osteoarthritis and 60 non-exposed (without knee osteoarthritis) individuals were studied in a prospective cohort study that was conducted from March 2018 to May 2019. The patients were chosen from those who referred to the Rheumatology Division in Sulaymaniyah, the Kurdistan Region of Iraq. EULAR and ACR diagnostic and classification criteria and radiographic confirmation for definite osteophyte were utilized to diagnose the primary knee osteoarthritis. Required data were collected using a questionnaire, taking blood samples and by conducting several laboratory tests.

Results: The mean age of the patients with knee osteoarthritis was 51.8 years. Female-to-male ratio was 2.1:1. It was seen that dyslipidemia increased two folds among patients with knee osteoarthritis than the non-exposed subjects. Patients and non-exposed subjects were significantly different in terms of dyslipidemia prevalence (p<0.013). Furthermore, all the lipid components were significantly abnormal in those with knee osteoarthritis.

Conclusion: Dyslipidemia is prevalent among knee osteoarthritis patients, and there is a significant association between knee osteoarthritis and high-density lipoprotein, total cholesterol, low-density lipoprotein, and triglyceride. Dyslipidemia prevention may reduce the development of knee osteoarthritis and cardiovascular comorbidities.

Key words: knee osteoarthritis, dyslipidemia, serum lipid components, radiography


As the most common chronic, heterogeneous, and debilitating arthritic disorder, osteoarthritis (OA) mainly impacts diarthrodial joints [1-5]. Quality of life can be negatively affected by osteoarthritis, which in turn raises the healthcare and social costs [6]. The prevalence of OA ranges from 3.8-70% depending on different regions of the world [7], and it has been reported to affect 1 million people in Iraq, Yemen, Saudi Arabia, and Syria [8]. In addition, it has been indicated that OA was more prevalent among men than women. However, studies demonstrated that beyond 50 women are more likely to have OA than same age men [9].

The most common type of OA is knee osteoarthritis (KOA) [10]. The prevalence of KOA has been reported to be 12% in those over the age of 55 years [11].

OA is associated with pain and functional limitations [12] and is typically believed to be the result of obesity and aging [13]. In addition to age and obesity, metabolic syndrome (MetS) has been referred to as a major risk factor for OA development [14]. Association between OA and MetS is referred to as metabolic OA, indicating the association between OA and obesity, dyslipidemia, and hypertension [15].

Due to the high prevalence of knee osteoarthritis (KOA) particularly in the middle-aged individuals, the debilitating effect of osteoarthritis and consequently has a negative impact on quality of life. Moreover, due to the reported association between OA and dyslipidemia, the present investigation was carried out in order to study the prevalence of dyslipidemia among individuals with symptomatic KOA.


Study design and sample: The present investigation was a prospective cohort study which was carried out in the Rheumatology Division in Sulaymaniyah, Iraqi Kurdistan from March 2018 to May 2019. For this purpose, 60 patients with symptomatic KOA (41 females and 19 males) were chosen as the exposed for the study. Following both ACR classification of OA of the knee [27] and EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis [28], 60 non-exposed (no symptomatic KOA) with the same age range were selected in order to be compared to the exposed.

Selection of the target sample was based on some inclusion and exclusion criteria. The inclusion criteria involved patient consent, age, duration of knee pain not exceeding 2 years, presence of definite osteophyte in at least one joint, and normal body mass index (BMI). Patients with possible secondary causes of dyslipidemia were excluded.

Data collection: The exposed and non-exposed individuals randomly visited the Rheumatology Division, and the required data were collected by conducting face-to-face interviews using a researcher-designed questionnaire.

Statistical analysis: In order to analyze the collected data, Statistical Package for Social Sciences version 25 was used. The descriptive results were expressed as mean ± standard deviation (SD). Normality of the data was verified using Kolmogorov Smirnov test. The categorical variables were analyzed through Chi-square test, and Fisher’s exact test was used when more than 20% of the cells were less than five. Pearson’s and Spearman’s tests were used for the correlation between the variables. Level of significance probability value (p-value) was set at 0.05.


A total of 60 patients with KOA were studied. Analyzing the collected data revealed that their mean age was 51.8 (±3.745) years. Regarding their sex, there were 41 (68.3%) females and 19 (31.7%) males, and the female-to-male ratio was 2.1:1 (See Table 1).

Table 1: Demographic characteristics of KOA cases

The results obtained from analyzing the data collected from the 60 non-exposed subjects indicated that their mean age was 50.95 (±5.077) years. In terms of their sex distribution, 41 (68.3%) females and 19 (31.7%) males were in the control group, with a female-to-male ratio of 2.1:1.

The study demonstrated that 34 cases (56.7%) had bilateral KOA and 26 (43.3%) unilateral KOA. Out of the unilateral cases, 14 had right-side while 12 had left-side KOA, respectively (See Table 2).

Table 2: Type and site of KOA pattern distribution

The results showed that KOA pain duration ranged from 3 to 18 months, with 47 cases (78.3%) having a disease span of less than 12 months, and 13 (21.7%) more than 12 months (See Figure 1).

Click here for Figure 1: Duration of KOA pain (months)

Comparing the cases and controls through t-test, revealed that levels of serum lipid had a significant increase in the KOA patients compared to the controls. There was a significant difference between the two groups in terms of all lipid variables including high-density lipoprotein (HDL) at a p-value of 0.001, total cholesterol (TC) at a p-value of 0.001, low-density lipoprotein (LDL) at a p-value of 0.019, and triglyceride (TG) at a p-value of 0.002 (See Table 3).

Table 3. Analyzing and comparing means with Independent sample T-test

P- Value {Sig (2-Tailed)}is significant whenever it is less than or equal to .05

According to the results obtained from the Chi-square test, the cases had significantly higher levels of abnormal TC, TG, LDL, and HDL compared to the control. Based on these results, it was concluded that KOA had a significant relationship with elevated level of TC (p-value=0.024), TG (p-value=0.016), LDL (p-value=0.018), and HDL (p-value=0.032) (See Table 4).

Click here for Table 4. Significant ratio of normal and abnormal percentage and distribution of lipids among exposed and non-exposed

Compared to the 15 controls (12.5%), 28 cases with KOA (23.3%) had different types of dyslipidemia, and this difference was significant, showing a significant relationship between KOA and dyslipidemia at a p-value of 0.013 (See Figure 2).

Click here for Figure 2: Dyslipidemia among KOA exposed and non-exposed

The results revealed that there was no statistically significant association between sex and age in patients with KAA in terms of dyslipidemia (See Table 5).

Click here for Table 5. Correlation of dyslipidemia with gender and age

The study revealed, that there was a significant relationship between dyslipidemia and pain duration in KOA patients (p<0.0001). Dyslipidemia was more common among patients with knee pain of more than 10 months. Also, dyslipidemia was significantly correlated with bilateral knee joint involvement at a p-value of 0.001 (See Table 6).

Table 6. Correlation of dyslipidemia with duration and joint pattern

Finally, there was a significant connection between pain duration of either 9 or 10 months and the site of knee joint involvement (p=0.004). The study revealed that bilateral involvement was more prevalent in patients with knee pain duration of 10 months (See Table 7).

Table 7. Correlation between joint pain pattern with duration of pain