POTENTIAL NEGATIVE EFFECTS OF OSTEOARTHRITIS ON THE CARDIOVASCULAR SYSTEM AND THE ROLE OF REHABILITATION IN THEIR REDUCTION
DOI:
https://doi.org/10.15547/tjs.2025.s.01.003Keywords:
degenerative musculoskeletal diseases, cardiovascular diseases, preventive care, physical activity, physical modalities, therapeutic exercisesAbstract
The aim of this report is to present the significance of osteoarthritis in occurrence and development of certain cardiovascular diseases, and the potential benefits of physical medicine therapeutic interventions for their prevention and treatment.
MATERIALS AND METHODS: A review was conducted of available scientific sources containing data on the impact of osteoarthritis on cardiovascular diseases and the role of rehabilitation in their prevention and treatment.
RESULTS: The review revealed evidence of a mutual connection between osteoarthritis and certain cardiovascular diseases. There are scientific data indicating common risk factors such as age, obesity, and genetics. Another mechanism affecting the cardiovascular system is the use of medication to control osteoarthritis symptoms. Non-steroidal drugs prescribed to reduce pain and inflammation may lead to cardiac damage. Pain from osteoarthritis reduces physical activity and leads to increased intake of pharmacological agents. Physical activity and therapeutic exercises can have a positive effect both on osteoarthritis and on accompanying cardiovascular conditions.
CONCLUSION: The potential impact of osteoarthritis on cardiovascular diseases is a focus of attention in recent years. Due to the presence of common risk factors and pathogenic mechanisms, research continues for potential therapeutic effects of physical modalities application for prevention and control of their progression.
References
Allen, K.D., Thoma, L.M, Golightly, Y.M. Epidemiology of osteoarthritis. Osteoarthritis Cartilage, 30(2):18 4-195, 2022. doi:10.1016/j.joca.2021.04.020
Biver, E., Berenbaum, F., Valdes, A.M., et al. Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Ageing Res Rev, 55:100946, 2019. doi:10.1016/j.arr.2019.100946
Yin, M., Xu, W., Pang, J., et al., Causal relationship between osteoarthritis with atrial fibrillation and coronary atherosclerosis: a bidirectional Mendelian randomization study of European ancestry. Front Cardiovasc Med, 10:1213672, 2023. doi:10.3389/fcvm.2023.1213672
Luo, .Q., Zhang, S., Yang, Q. et al., Causal factors for osteoarthritis risk revealed by mendelian randomization analysis. Aging Clin Exp Res, 36(1):176. 2024. doi:10.1007/s40520-024-02812-9
Yin, X., Wang, Q., Tang, Y. et al. Research progress on macrophage polarization during osteoarthritis disease progression: a review. J Orthop Surg Res, 19, 584, 2024. https://doi.org/10.1186/s13018-024-05052-9
Aubourg, G., Rice, S.J., Bruce-Wootton, P., Loughli, J. Genetics of osteoarthritis. Osteoarthritis Cartilage, 30(5):636-649, 2022. doi:10.1016/j.joca.2021.03.002
Rehm, M., Büchele, G., Peter, R.S., et al., Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis. PLoS One, 15(12):e0242814, 2020. doi:10.1371/journal.pone.0242814
Courties, A., Kouki, I., Soliman, N., et. al. Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthritis and cartilage, 32(11), 1397–1404, 2024. doi: 10.1016/j.joca.2024.07.014
GBD 2019: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. https://vizhub.healthdata.org/gbd-results/.
Long, H., Liu, Q., Yin, H. et al., Prevalence trends of site-specific osteoarthritis from 1990 to 2019: Findings from the global burden of disease study 2019. Arthritis Rheumatol, 74(7): 1172-1183, 2022.
Cieza, A., Causey, K., Kamenow, K. et al., Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10267): 2006–2017, 2020.
GBD 2021 Osteoarthritis Collaborators Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. Rheumatology, 5(9), e508–e522, 2023. https://doi.org/10.1016/S2665-9913(23)00163-7
Steinmetz, J. D. et al., Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study The Lancet Rheumatology, 5(9), e508 - e522, 2021.
Hindricks, G., Potpara, T., Dagres, N., et al., ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 42(5):373-498, 2021. doi:10.1093/eurheartj/ehaa612
Vizzardi, E., Curnis, A., Latini, M.G., et al., Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown), 15(3):235-253, 2014. doi:10.2459/JCM.0b013e328358554b
Kannel, W.B., Feinleib, M., McNamara, P.M., et al., An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol, 110(3):281-290, 1979. doi:10.1093/oxfordjournals.aje.a112813
Ko, D., Rahman, F., Schnabel, R.B., et al., Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol, 13(6):321-332,2016. doi:10.1038/nrcardio.2016.45
Wilke, T., Groth, A., Mueller, S., et al., Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace,15(4):486-493,2013. doi:10.1093/europace/eus333
Benjamin, E.J., Muntner, P., Alonso, A., et al., Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation,139(10):e56-e528, 2019. doi:10.1161/CIR.0000000000000659
Wang, S., Liu, Y., Wu, K., et al., Osteoarthritis and risk of cardiovascular diseases: A Mendelian randomization study. Injury, 2023. doi:10.1016/j.injury.2023.03.026
Tran, J., Norton, R., Conrad, N., et al. Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study. PLoS Med, 15(3):e1002513, 2018. doi:10.1371/journal.pmed.1002513
Nielen, M.M., van Sijl, A.M., Peters, M.J., et al., Cardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary care. BMC Musculoskelet Disord, 13:150, 2012. doi:10.1186/1471-2474-13-150
Wang, H., Bai, J., He, B., Hu, X., Liu, D., Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies. Sci Rep, 6:39672, 2016. doi:10.1038/srep39672
Sewell, J., Hussain, S.M., Wang, Y., et al., Association between arthritis and cardiovascular risk factors in community-based adults: an opportunity to target cardiovascular risk. BMC Cardiovasc Disord, 22(1):232, 2022. doi:10.1186/s12872-022-02674-x
Liberale, L., Montecucco, F., Tardif, J.C., et al., Inflamm-ageing: the role of inflammation in age-dependent cardiovascular disease. Eur Heart J., 41(31):2974-2982, 2020. doi:10.1093/eurheartj/ehz961
Chadha, R., Revealed aspect of metabolic osteoarthritis. J Orthop, 13(4):347-351, 2016. doi:10.1016/j.jor.2016.06.029
Vincent, T.L., IL-1 in osteoarthritis: time for a critical review of the literature. F1000Res, 8:F1000 Faculty Rev-934, 2019. doi:10.12688/f1000research.18831.1
Vaiciuleviciute, R., Bironaite, D., Uzieliene, I., et al., Cardiovascular Drugs and Osteoarthritis: Effects of Targeting Ion Channels. Cells, 10(10):2572, 2021. doi:10.3390/cells10102572
Jenei-Lanzl, Z., Meurer, A., Zaucke, F., Interleukin-1β signaling in osteoarthritis – chondrocytes in focus, Cellular Signalling, 53:212-223, 2019. https://doi.org/10.1016/j.cellsig.2018.10.005.
Schulman, S., Aisenberg, J., Are NSAIDs Double Trouble?. J Am Coll Cardiol, 72(3):268-270, 2018. doi:10.1016/j.jacc.2018.04.062
Danelich, I.M., Wright, S.S., Lose, J.M., et al., Safety of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease. Pharmacotherapy, 35(5):520-535, 2015. doi:10.1002/phar.1584
Park, D., Park, Y.M., Ko, S.H., et al., Association between knee osteoarthritis and the risk of cardiovascular disease and the synergistic adverse effects of lack of exercise. Sci Rep, 13(1):2777, 2023. doi:10.1038/s41598-023-29581-1
Veronese, N. et al. Association between lower limb osteoarthritis and incidence of depressive symptoms: Data from the osteoar thritis initiative. Age Ageing, 46, 470–476, 2017. https://doi.org/10.1093/ageing/afw216
Aydın, G., Balkışlı, B.Ç., Comparison of disease severity, physical fitness parameters, and physical activity levels according to pain intensity in patients with knee osteoarthritis: A cross-sectional study. Arch Health Sci Res, 12:0011,2025. doi: 10.5152/ArcHealthSciRes.2025.25011.
Pua, Y.H., Tan, B.Y., Low, J., et al., Discordance between self-reported and performance-based physical function in patients with knee osteoarthritis: associations with pain intensity and negative affect. Osteoarthr Cartil, 31:S153-S154.
Dunlop, D,D,, Song, J., Semanik, P.A., et al., Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis Rheum, 63(1):127-136. 2011.
Almeida, C.C., de, DeSantana J.M., Durigan, J.L.Q., Azevedo, P.G., Relationship between the ability to walk long distances and to climb up and down stairs with the health-related quality of life of older adults with sympto matic knee osteoarthritis. Rev Bras Geriatr Gerontol, 24(5), 2021.
Aadil, Ameer Ali, Sana, Naqi, Rabbia, Naseer, Shoaib Waqas, et al., Comparison of Open vs. Closed Kinetic Chain Exercises in Knee Osteoarthritis Rehabilitation. JHWCR, e452, 2025. https://doi.org/10.61919/ztrp0f25.
Rabbitts, J.A., Holley, A.L., Karlson, C.W., Palermo, T.M., Bidirectional associations between pain and physical activity in adolescents. Clin J Pain, 30(3):251–8, 2014.
Nicholas, J. Burrows, Benjamin, K. Barry, Daina, L. Sturnieks, et al., The Relationship Between Daily Physical Activity and Pain in Individuals with Knee Osteoarthritis, Pain Medicine, 21(10):2481–2495, 2020. https://doi.org/10.1093/pm/pnaa096
Fingleton, C., Smart, K., Doody, C., Exercise-induced hypoalgesia in people with knee osteoarthritis with normal and abnormal conditioned pain modulation. Clin J Pain, 33(5):395–404. 2017.
Henriksen, M., Klokker, L., Graven-Nielsen, T., et al. Association of exercise therapy and reduction of pain sensitivity in patients with knee osteoarthritis: A randomized controlled trial. Arthritis Care Res, 66(12):1836–43, 2014.
Ericsson, Y.B., Roos, E.M., Owman, H., Dahlberg, L.E., Association between thigh muscle strength four years after partial meniscectomy and radiographic features of osteoarthritis 11 years later. BMC Musculoskelet Disord, 20(1):512, 2019. doi:10.1186/s12891-019-2875-7
Runhaar, J., Luijsterburg, P., Dekker, J., Bierma-Zeinstra, S.M., Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; a systematic review. Osteoarthritis Cartilage, 23(7):1071–82, 2015.
Cross, M., Smith, E., Hoy, D., et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis,73(7):1323-1330, 2014. doi:10.1136/annrheumdis-2013-204763
Liu, M., Jin, F., Yao, X., Zhu, Z., Disease burden of osteoarthritis of the knee and hip due to a high body mass index in China and the USA: 1990-2019 findings from the global burden of disease study 2019. BMC Musculoskelet Disord, 23(1):63,2022. doi:10.1186/s12891-022-05027-z
Mratskova, G., Application of the Low Frequency and Low-Intensity Electrostatic Field in Rehabilitation Programs for Patients with Musculoskeletal Disorders. Electrostatics - Fundamentals and Modern Applications. IntechOpen, 2025. Available at: http://dx.doi.org/10.5772/intechopen.1007878.
Mratskova, G., Comparative study of the Deep Oscillation therapy effects and some preformed physical factors in treatment and rehabilitation of patients with osteoarthritis [thesis]. Stara Zagora: Trakia University, Faculty of Medicine, 2018.
von Stengel, S., Teschler, M., Weissenfels, A., et. al., Effect of deep oscillation as a recovery method after fatiguing soccer training: A randomized cross-over study. J Exerc Sci Fit, 16(3):112-117, 2018. doi:10.1016/j.jesf.2018.10.004
Trybulski, R., Biolik, G., Kuczmik, W., et al. Application of deep oscillation therapy in the treatment of peripheral arterial diseases. Med. Perspekt, 28(3), 116–127, 2023. https://doi.org/10.26641/2307-0404.2023.3.289207
51.Vladeva, E., Mihaylova, M., Panayotova, L., Deep Oscillations- reducing edema and improving kinesiology in the early stages after knee joint arthroplasty. Journal of IMAB, 27(1):3577-358, 2021. DOI: 10.5272/ jimab.2021271.3577
Thomas, D.T., Eapen, C., Hegde, A.S., et al. Effectiveness Of The Core Activation And Rehabilitation Exercises For Knee Osteoarthritis - Program (CARE -KOA©) Among Patients Diagnosed With Knee Osteoarthritis. F1000Research, 14:496, 2025. https://doi.org/10.12688/f1000research.163321.4
Roos, E.M., Grønne, D.T., Thorlund, J.B., Skou, S.T., Knee and hip osteoarthritis are more alike than different in baseline characteristics and outcomes: a longitudinal study of 32,599 patients participating in supervised education and exercise therapy, Osteoarthritis Cartilage, 30(5):681-688, 2022. doi:10.1016/j.joca.2022.02.001
Fransen, M., McConnell, S., Harmer, A.R., et al., Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev, 49(24):1554–7, 2015.
Focht, B.C., Ewing, V., Gauvin, L., Rejeski, W.J., The unique and transient impact of acute exercise on pain perception in older, overweight, or obese adults with knee osteoarthritis. Ann Behav Med, 24(3):201-210, 2002. doi:10.1207/S15324796ABM2403_05
Wideman, T.H., Finan, P.H., Edwards, R.R., et al., Increased sensitivity to physical activity among individuals with knee osteoarthritis: relation to pain outcomes, psychological factors, and responses to quantitative sensory testing. Pain, 155(4):703-711, 2014. doi:10.1016/j.pain.2013.12.028
Carpenter, R.W., Acuff, S.F., Meshesha, L.Z., The Role of Environmental Context and Physical Activity in Prescribed Opioid Use and Pain in Daily Life among Patients With Chronic Low Back Pain. Ann Behav Med, 57(7):541-550, 2023. doi:10.1093/abm/kaac080
Sandal, L.F., Roos, E.M., Bogesvang, S.J., ThorlundJB.Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscu lar exercise in individuals with knee and hip pain. Osteoarthritis Cartilage, 24(4):589–92, 2016.
Engin, B., Willis, S.A., Malaikah, S., et al., The effect of exercise training on adipose tissue insulin sensitivity: A systematic review and meta-analysis. Obes Rev, 23(7):e13445, 2022. doi:10.1111/obr.13445
Dempsey, P.C., Rowlands, A.V., Strain, T., et al., Physical activity volume, intensity, and incident cardiovascular disease. Eur Heart J., 43(46):4789-4800, 2022. doi:10.1093/eurheartj/ehac613
Tonga, E., Worboys. H., Evans, R.A., et al., Physical activity guidelines for adults with type 2 Diabetes: Systematic review. Diabetes Res Clin Pract, 220:111982, 2025. doi:10.1016/j.diabres.2024.111982
Colón-Emeric, C.S., Whitson, H.E., Pavon, J., Hoenig, H., Functional decline in older adults. Am Fam Physician, 88(6):388-394, 2013.
Valenti, G., Bonomi, A.G., Westerterp, K.R., Walking as a Contributor to Physical Activity in Healthy Older Adults: 2 Week Longitudinal Study Using Accelerometry and the Doubly Labeled Water Method. JMIR Mhealth Uhealth, 4(2):e56, 2016. doi:10.2196/mhealth.5445
Bellettiere, J., LaMonte, M.J., Evenson, K.R., et al., Sedentary behavior and cardiovascular disease in older women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study. Circulation, 139(8):1036-1046, 2019. doi:10.1161/CIRCULATIONAHA.118.035312
Perry, A.S., Dooley, E.E., Master, H., et al., Physical Activity Over the Lifecourse and Cardiovascular Disease. Circ Res, 132(12):1725-1740,2023. doi:10.1161/CIRCRESAHA.123.322121
Anderson, L., Sharp, G.A., Norton, R.J., et al., Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev, 6(6):CD007130, 2017. doi:10.1002/14651858.CD007130.pub4
Eijsvogels, T.M.H., Maessen, M.F.H., Bakker, E.A., et al., Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open, 3(7):e2011686, 2020. doi:10.1001/jamanetworkopen.2020.11686
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
