Elizabeth Schulman1, Susan J Bartlett2, Orit Schieir3, Kathleen M Andersen1, Gilles Boire4, Janet E Pope5, Carol Hitchon6, Shahin Jamal7, J Carter Thorne8, Diane Tin8, Edward C Keystone9, Boulos Haraoui10, Susan M Goodman1, Vivian P Bykerk11. 1. Hospital for Special Surgery, Weill Cornell Medical College, New York, New York. 2. McGill University, Montreal, Quebec, Canada. 3. University of Toronto, Toronto, Ontario, Canada. 4. Université de Sherbrooke, Sherbrooke, Quebec, Canada. 5. St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada. 6. University of Manitoba, Winnipeg, Manitoba, Canada. 7. University of British Columbia, Vancouver, British Columbia, Canada. 8. Southlake Regional Health Centre, Newmarket, Ontario, Canada. 9. Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 10. Institut de Rhumatologie, Montreal, Quebec, Canada. 11. Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Obesity is implicated in rheumatoid arthritis (RA) development, severity, outcomes, and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the 3 years following RA diagnosis. METHODS: Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of early RA patients treated by rheumatologists using guideline-based care. sREM was defined as Disease Activity Score in 28 joints (DAS28) <2.6 for 2 consecutive visits. Patients were stratified by body mass index (BMI) as healthy (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), and obese (≥30 kg/m2 ). Cox regression was used to estimate the effect of the BMI category on the probability of achieving sREM over the first 3 years, controlling for age, sex, race, education, RA duration, smoking status, comorbidities, baseline DAS28, Health Assessment Questionnaire disability index, C-reactive protein level, and initial treatment. RESULTS: Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI, overweight patients (hazard ratio [HR] 0.75 [95% confidence interval (95% CI) 0.58-0.98]) and obese patients (HR 0.53 [95% CI 0.39-0.71]) were significantly less likely to achieve sREM. CONCLUSION: Rates of overweight and obesity were high (69%) in this early RA cohort. Overweight patients were 25% less likely, and obese patients were 47% less likely, to achieve sREM in the first 3 years, despite similar initial disease-modifying antirheumatic drug treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RA patients.
OBJECTIVE:Obesity is implicated in rheumatoid arthritis (RA) development, severity, outcomes, and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the 3 years following RA diagnosis. METHODS: Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of early RApatients treated by rheumatologists using guideline-based care. sREM was defined as Disease Activity Score in 28 joints (DAS28) <2.6 for 2 consecutive visits. Patients were stratified by body mass index (BMI) as healthy (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), and obese (≥30 kg/m2 ). Cox regression was used to estimate the effect of the BMI category on the probability of achieving sREM over the first 3 years, controlling for age, sex, race, education, RA duration, smoking status, comorbidities, baseline DAS28, Health Assessment Questionnaire disability index, C-reactive protein level, and initial treatment. RESULTS: Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI, overweight patients (hazard ratio [HR] 0.75 [95% confidence interval (95% CI) 0.58-0.98]) and obesepatients (HR 0.53 [95% CI 0.39-0.71]) were significantly less likely to achieve sREM. CONCLUSION: Rates of overweight and obesity were high (69%) in this early RA cohort. Overweight patients were 25% less likely, and obesepatients were 47% less likely, to achieve sREM in the first 3 years, despite similar initial disease-modifying antirheumatic drug treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RApatients.
Authors: Yi Xuan Lee; Yu Heng Kwan; Ka Keat Lim; Chuen Seng Tan; Nai Lee Lui; Jie Kie Phang; Eng Hui Chew; Truls Ostbye; Julian Thumboo; Warren Fong Journal: Singapore Med J Date: 2019-06 Impact factor: 1.858
Authors: Brian J Andonian; Ching-Heng Chou; Olga R Ilkayeva; Timothy R Koves; Margery A Connelly; William E Kraus; Virginia B Kraus; Kim M Huffman Journal: Front Immunol Date: 2019-06-27 Impact factor: 7.561
Authors: Stefano Alivernini; Barbara Tolusso; Maria Rita Gigante; Luca Petricca; Laura Bui; Anna Laura Fedele; Clara Di Mario; Roberta Benvenuto; Francesco Federico; Gianfranco Ferraccioli; Elisa Gremese Journal: Sci Rep Date: 2019-07-18 Impact factor: 4.379
Authors: Jesús A Valero-Jaimes; Ruth López-González; María A Martín-Martínez; Carmen García-Gómez; Fernando Sánchez-Alonso; Jesús T Sánchez-Costa; Carlos González-Juanatey; Eva Revuelta-Evrad; César Díaz-Torné; Cruz Fernández-Espartero; Carolina Pérez-García; Vicenç Torrente-Segarra; Ginés Sánchez-Nievas; Trinidad Pérez-Sandoval; Pilar Font-Ugalde; María L García-Vivar; Elena Aurrecoechea; Olga Maiz-Alonso; Ramón Valls-García; José A Miranda-Filloy; Javier Llorca; Santos Castañeda; Miguel A Gonzalez-Gay Journal: J Clin Med Date: 2021-01-20 Impact factor: 4.241
Authors: Sook Yan Lee; Fowzia Ibrahim; Brian D M Tom; Elena Nikiphorou; Frances M K Williams; Heidi Lempp; David L Scott Journal: Arthritis Res Ther Date: 2021-11-04 Impact factor: 5.156