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Obese, overweight early RA patients experienced lower remission rates

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Patients with early rheumatoid arthritis who were overweight or obese experienced lower rates of remission compared with normal weight counterparts, according to research presented at the annual congress of the European League Against Rheumatism in Madrid.

“These data reinforce the line between obesity and inflammation and establish that BMI is one of the few modifiable variables influencing the major outcomes in RA,” researcher Elisa Gremese, MD, of the division of rheumatology and affine sciences, Catholic University of the Sacred Heart, Rome, said in a press release.

Gremese and colleagues studied 346 patients (76.3% women) with early rheumatoid arthritis (ERA; symptom duration less than 1 year) who adhered to strict follow-up visits, received methotrexate up to 25 mg weekly with or without steroids, then a combination with a tumor necrosis factor (TNF) blocker if a response of good or better (EULAR criteria) was unmet. ACR/EULAR core data were registered, BMI was collected and clinical remission was evaluated (Disease Activity Score [DAS] and Clinical Disease Activity Index [CDAI] values) at each visit.

One hundred sixty-eight patients were normal weight; 135, overweight; and 43, obese. Age (P<.001), baseline inflammatory markers (ESR, P=.009; CRP, P<.001), DAS (P=.001), CDAI (P=.01) and HAQ (P=.001) correlated with BMI values.

Using DAS and CDAI criteria, lower rates of remission were sustained at 6 and 12 months by overweight (12 months; DAS, 28.7%; CDAI, 37.1%) and obese patients (34.1%, 31%) than patients of normal weight (49.1%, 50%) (P=.008 for DAS; P=.07 for CDAI).

More overweight (28.8%) and obese (28.1%) patients were treated with anti-TNFs after 12 months of follow-up, compared with normal weight patients (16.2%).

In multivariate analysis, researchers observed significant associations between risk for not obtaining sustained DAS and CDAI remission at 12 months with female sex (OR=2.44; OR=1.97), baseline HAQ of 1.5 or greater (OR=1.56; OR=1.76), and BMI of 25 or greater (OR=2.22; OR=1.81).

“Data suggest that in ERA patients, not only obesity but also overweight, associates with a lower percentage of success in obtaining remission,” the researchers concluded.

For more information:

Gremese E. OP0178: The Body Mass Index: A Determinant of Remission in Early Rheumatoid Arthritis. Presented at: EULAR 2013; June 12-15, Madrid.