Abstract Background Previous studies have suggested that metabolic syndrome is associated with osteoarthritis (OA). However, analyses have not addressed whether levels of individual metabolic syndrome components are related to OA. This study was undertaken to examine the relationship of metabolic syndrome and its components with radiographic and symptomatic knee OA Objective To assess the impact of metabolic syndrome and its components on the degree of structural damage and function impairment in a sample of Egyptian patients with symptomatic primary knee OA. Patients and Methods In this study, 116 Egyptian osteoarthritic patients were included, Patients were divided into 2 groups: Group A: includes 58 osteoarthritic patients with metabolic syndrome. Group B: includes 58 osteoarthritic patients without metabolic syndrome. Results There was a positive correlation detected between HAQ and hypertension with P-Value 0.002. There was a positive correlation detected between WOMAC and hypertension with P-Value 0.000.we found that OA was sever in hypertensive patients, old age, patients with high waist circumference and high levels of CRP, TG, FBG and 2HPP with P-value > 0.001. While there was no correlation between X-ray grading with and ESR, uric acid, cholesterol, LDL, HDL, HBA1C and insulin resistance with P-Value > 0.05 Conclusion We concluded that patients with knee OA and metabolic syndrome has more radiological damage and severe grades of functional disability in comparative to patients with OA without MS.