Julia Goossens1, Baptiste Coustet1, Elisabeth Palazzo1, Philippe Dieudé1, Sébastien Ottaviani2. 1. Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris; and AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France. 2. Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris; and AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France. sebastien.ottaviani@aphp.fr.
Abstract
OBJECTIVES: Body mass index (BMI) might affect rheumatoid arthritis (RA) outcomes. Clinical assessment of swollen joint count (SJC) might also be affected by obesity in terms of obesity-related excess adipose tissue. In this study, we compared ultrasonography (US) and clinical examination in assessing the effect of BMI on RA disease activity assessment. METHODS: This was a single-centre study including RA (ACR/EULAR criteria) patients. US assessment was performed by one trained rheumatologist blinded to clinical data. US synovitis was defined as grey-scale score ≥2 and/or power Doppler score ≥1. The primary outcome measure was difference in SJC (ΔSJC) between clinical and US assessment (US-clinical examination). The secondary outcome was to evaluate the difference between clinical and US assessment of the Disease Activity Score in 28 joints (ΔDAS28) in the 3 BMI subgroups according to the WHO classification. RESULTS: We included 76 RA patients (mean age 53.8 ± 11.8 years; 67% female). Overall, 28 (36.8%), 33 (43.4%) and 15 (19.7%) were normal weight, overweight and obese, respectively. Baseline characteristics did not differ between the 3 BMI subgroups. US-determined SJC was significantly higher than clinical-determined SJC for overweight and obese RA patients: p=0.001 and p=0.049, respectively. The DAS28 was higher with US than clinical examination within the overweight group only (p=0.002). One-way analysis of variance (ANOVA) revealed a significant difference between ΔDAS28 among the 3 BMI subgroups (p=0.046). CONCLUSIONS: In high BMI RA patients both SJC and DAS28 seem to be undervalued by clinical assessment when compared to US.
OBJECTIVES: Body mass index (BMI) might affect rheumatoid arthritis (RA) outcomes. Clinical assessment of swollen joint count (SJC) might also be affected by obesity in terms of obesity-related excess adipose tissue. In this study, we compared ultrasonography (US) and clinical examination in assessing the effect of BMI on RA disease activity assessment. METHODS: This was a single-centre study including RA (ACR/EULAR criteria) patients. US assessment was performed by one trained rheumatologist blinded to clinical data. US synovitis was defined as grey-scale score ≥2 and/or power Doppler score ≥1. The primary outcome measure was difference in SJC (ΔSJC) between clinical and US assessment (US-clinical examination). The secondary outcome was to evaluate the difference between clinical and US assessment of the Disease Activity Score in 28 joints (ΔDAS28) in the 3 BMI subgroups according to the WHO classification. RESULTS: We included 76 RApatients (mean age 53.8 ± 11.8 years; 67% female). Overall, 28 (36.8%), 33 (43.4%) and 15 (19.7%) were normal weight, overweight and obese, respectively. Baseline characteristics did not differ between the 3 BMI subgroups. US-determined SJC was significantly higher than clinical-determined SJC for overweight and obese RApatients: p=0.001 and p=0.049, respectively. The DAS28 was higher with US than clinical examination within the overweight group only (p=0.002). One-way analysis of variance (ANOVA) revealed a significant difference between ΔDAS28 among the 3 BMI subgroups (p=0.046). CONCLUSIONS: In high BMI RApatients both SJC and DAS28 seem to be undervalued by clinical assessment when compared to US.
Authors: Nadia M T Roodenrijs; Melinda Kedves; Attila Hamar; György Nagy; Jacob M van Laar; Désirée van der Heijde; Paco M J Welsing Journal: RMD Open Date: 2021-01
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
Authors: György Nagy; Nadia M T Roodenrijs; Désirée van der Heijde; Jacob M van Laar; Paco M J Welsing; Melinda Kedves; Attila Hamar; Marlies C van der Goes; Alison Kent; Margot Bakkers; Polina Pchelnikova; Etienne Blaas; Ladislav Senolt; Zoltan Szekanecz; Ernest H Choy; Maxime Dougados; Johannes Wg Jacobs; Rinie Geenen; Johannes Wj Bijlsma; Angela Zink; Daniel Aletaha; Leonard Schoneveld; Piet van Riel; Sophie Dumas; Yeliz Prior; Elena Nikiphorou; Gianfranco Ferraccioli; Georg Schett; Kimme L Hyrich; Ulf Mueller-Ladner; Maya H Buch; Iain B McInnes Journal: Ann Rheum Dis Date: 2021-08-18 Impact factor: 19.103