Immunometabolic crosstalk in knee osteoarthritis: a bibliometric and translational analysis (2000-2025)

Knee osteoarthritis (KOA) has traditionally been regarded as a localized degenerative joint disorder; however, accumulating evidence increasingly supports a critical role for immunometabolic dysfunction, chronic low-grade inflammation, and systemic metabolic alterations in disease initiation and progression. Although research in this multidisciplinary field is growing rapidly, the global intellectual structure, emerging mechanistic themes, and the evolution of the translation of KOA research remain inadequately documented.

This study used a multi-database bibliometric and scientometric analysis with a hypothesis-generating translational synthesis, rather than a systematic review of intervention effects. We analyzed publications indexed in Web of Science, Scopus, and PubMed from 2000 to 2025. We used CiteSpace, VOSviewer, and Bibliometrix to analyze global research trends, collaboration networks, intellectual structure, and emerging themes in immunometabolic and inflammatory mechanisms in KOA.

A total of 783 publications were included. Annual research output increased substantially after 2015, reflecting growing recognition of systemic contributors to KOA. The United States and China were the largest contributors to the growth of international partnerships. Co-citation, keyword, and thematic analyses showed increasing research attention to metabolic syndrome, oxidative stress, innate immune activation, multimorbidity, and inflammatory signaling alongside traditional cartilage-focused research. Biomarker discovery, lifestyle intervention, phenotype stratification, and precision-intervention-focused therapies were emerging research hotspots, indicating the growing translational importance of metabolic and immune-mediated mechanisms in the pathogenesis of KOA.

This analysis indicates increasing research attention to systemic immunometabolic factors alongside established joint-centered models of KOA. The identified research trajectories offer crucial translational insights and help inform the design of integrated approaches for risk stratification, prevention, and personalized management strategies involving targeting metabolic dysfunction, inflammatory signaling, and immune-mediated pathways in osteoarthritis.