New data from France suggest that asthma and other atopic conditions may accelerate osteoarthritis progression and increase the likelihood of joint replacement, indicating a possible link between type 2 inflammation and joint degeneration.

However, new research presented at the French Congress of Rheumatology in Paris suggests that the link between atopic diseases and osteoarthritis (OA) may be stronger than previously thought.

In 2023, a retrospective US study found that atopic diseases were associated with an increased risk for OA, with the risk increasing by 1.58-fold overall and 2.15-fold among individuals with both asthma and atopic dermatitis. Previous studies have shown that mast cells play a key role in atopic inflammation in OA.

“These cells are probably few in number but appear highly active. They release enzymes, including tryptase, which likely contribute to cartilage damage and pain,” said Augustin Latourte, MD, rheumatologist at Hôpital Lariboisière, Paris, France.

Severe Disease Signal

The association between atopy and OA, which has long been overlooked, has recently been reinforced by research conducted on the French Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort. According to this study, called ATOPOA, the presence of atopy in patients with OA also appears to be associated with more severe and rapidly progressing OA.

To demonstrate this, Kimberley Dolium, MD, from the Department of Rheumatology of Saint-Antoine Hospital, Paris, and her colleagues analyzed 717 patients with gonarthrosis or coxarthrosis.

Of the 66 participants with atopic disease, 42.2% had severe radiographic OA, defined as Kellgren-Lawrence grade 4 compared with 24% in the nonatopic group. After adjusting for confounders, atopy was associated with a 2.46-fold increased risk for severe disease.

During the 7 years of follow-up, individuals with atopic disease had a 2.02-fold higher risk for knee or hip replacement surgery.

Despite the high prevalence of both conditions, their association has received limited attention.

According to Latourte, asthma often affects younger individuals, whereas OA predominantly affects older adults. “These are initially fairly distinct populations,” he said. In addition, a history of asthma may be well documented in individuals treated for OA.

Owing to epidemiologic changes and rising pollution levels, pulmonologists have reported more cases of late-onset asthma. “We are just beginning to perceive an overlap between the two diseases,” Latourte said.

He emphasized that asthma does not account for all cases of OA. Rather, “the atopic phenomenon appears to represent a new risk factor for OA progression, similar to obesity.”

Comparison with obesity is clinically relevant. Several anti-obesity agents from the class of GLP-1 agonists have been investigated for the treatment of OA, both systemically in individuals with obesity and OA and via intra-articular injection in knee OA.

Could the same be true for asthma treatment? “That is the question that now arises: Biologic agents used for severe asthma and atopic dermatitis have a benefit against OA. Researchers are currently evaluating whether individuals with asthma who receive biologic therapy have a lower risk for OA progression compared with those not treated,” Latourte said.

Future interventional trials should be conducted in populations with both asthma and OA.

This story was translated from MediQuality, part of the Medscape Professional Network.