Obesity and osteoarthritis comorbidity: Insights from Ayurveda

Obesity and osteoarthritis are globally reaching epidemic proportions. Their concomitant association is well-known. The cumulative impact of these conditions on morbidity and the quality-of-life is sizeable, particularly for the aged. Obesity leading to osteoarthritis of the weight-bearing joints is well-appreciated. Inversely, however it is less emphasised that osteoarthritis of big joints of the lower limbs contributes to obesity because of the resultant physical inactivity. The increased adiposity is known to secrete proinflammatory cytokines that adds to the biomechanical cause of osteoarthritis. Besides mechanical and inflammatory mechanisms, genetic factors also play a causative role in both obesity and osteoarthritis as separate and concomitant disorders. The genetic and epigenetic mechanisms are gradually being unravelled for the comorbidity of obesity and osteoarthritis. Thus, the molecular pathophysiology of the concomitant existence of obesity and osteoarthritis is highly intriguing. Identifying the appropriate choice and sequence of therapeutic targets for reversal of this complex pathogenesis is a challenging task. Ayurvedic understanding of this comorbidity and experiential therapeutic base can offer a strategy for the prevention and management of the disorders. Sthaulya and Sandhigatavata are the respective clinical syndromes, described in Ayurveda for obesity and osteoarthritis. The imbalance in the respective Dhatvagni (metabolic paths) of Meda-Dhatu (adipose tissue) and Asthi-Dhatu (bone tissue) is the putative central pathogenetic mechanism involved for the comorbidity. The present article analyses some of the insights and experience from Ayurveda so as to provoke a meaningful debate on the opportunities for integrative care for obesity related osteoarthritis through reverse pharmacology path.