Obese Patients With Rheumatoid Arthritis Less Likely to Achieve Remission

Body mass index (BMI) scores can impact disease activity in patients with rheumatoid arthritis (RA). New research presented at the 2017 American College of Rheumatology's Annual Meeting in San Diego, California, explored associations between BMI and disease remission or low disease activity and functional ability in RA.

Researchers determined that patients with RA and higher BMI have lower rates of remission and higher rates of disability. They suggest that weight screening and management should be a part of RA management.

“Obesity is increasing in prevalence and represents a global health concern. It has been implicated as a risk factor for developing RA, and is an increasingly prevalent comorbidity seen on first presentation of RA,” Elena Nikiphorou, MD, a researcher in the Academic Rheumatology Department at King’s College, London, and a lead author of the study, said in a statement. “There is growing recognition that the inflammatory states mediated by obesity and those by inflammatory rheumatic diseases share common pathways.”

RA causes pain, stiffness, swelling, and limitation in multiple joints and inflammation can develop in other organs. Previous research has linked inflammation, obesity, and joint dysfunction, and the purpose of this study was to more clearly define how these conditions are associated with clinical disease activity and functional disability for patients with RA.

The researchers used data from the Early RA Study (ERAS) and the Early RA Network (ERAN), both of which were multicenter RA inception cohorts in the United Kingdom. There was a total of 1465 patients with a median follow-up of 10 years and a maximum follow-up of 25 years in ERAS, and a total of 1236 patients with a median follow-up of 6 years and a maximum follow-up of 10 years in ERAN.

The study found that 37.2% of RA patients were overweight and 21.3% were obese. BMI increased over 5 years for patients in both the ERAS and ERAN groups. Adjusted for age, sex, and year of recruitment, a higher BMI was associated with a reduced likelihood of patients with RA achieving low disease activity—based on scores of Remission-DAS and Low-DAS—and increased odds of disability by 63%.

“Our study’s findings demonstrate the increasing prevalence of obesity in RA patients and its negative consequences on disease activity, achieving a treat-to-target low disease activity goal and good functional outcomes,” said Nikiphorou. “Obesity is potentially a reversible comorbidity and successfully treating it can contribute to better disease activity and functional outcomes. Based on our data, there is a strong argument to include obesity screening and management as a central part of all treatment plans for RA patients.”