Obesity as a systemic modulator of musculoskeletal and rheumatic disease: a narrative review with emphasis on the Middle East and North Africa (MENA) region

Abstract Background Obesity is increasingly recognized as a critical systemic modulator of musculoskeletal (MSK) and rheumatic diseases, influencing disease onset, severity, radiographic progression, and therapeutic response. Despite its growing global prevalence, the impact of obesity across the full spectrum of MSK disorders has not been comprehensively evaluated, and clinical guidance remains limited. Methods We conducted a comprehensive narrative review of PubMed/MEDLINE, EMBASE, Scopus, and World Health Organization (WHO) databases through December 2024. Obesity or elevated body mass index (BMI) was examined in relation to various MSK and rheumatic disorders, including osteoarthritis (OA), rheumatoid arthritis (RA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE), tendinopathies, and fibromyalgia. Results Obesity exerts mechanical, metabolic, and immunological effects across all evaluated MSK disorders. Evidence suggests that it accelerates OA onset and structural damage, increases RA disease activity and radiographic progression, impairs SpA structural outcomes and reduces biologic therapy efficacy, elevates SLE disease activity and associated metabolic comorbidities, contributes to metabolic tendinopathy, and worsens fibromyalgia symptom burden. Regional data from the MENA region are consistent with global trends. Evidence remains limited regarding sacroiliac joint inflammation and tendinopathy specifically in obese populations. Conclusions Obesity should be considered as a modifiable predictor of MSK disease severity across multiple disorders. Effective weight management, obesity-adapted monitoring protocols, and region-specific research are essential to mitigate the burden of obesity on musculoskeletal health worldwide.