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Overweight Status, Obesity Linked With High Degree of Synovitis in RA
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SAN DIEGO — Data from a press release issued at the American College of Rheumatology Annual Meeting demonstrate overweight status and obesity are associated with a greater degree of synovitis in patients with rheumatoid arthritis from disease onset to stable remission.
According to the researchers, their findings suggest BMI control be a primary target throughout the course of RA disease.
“Obesity incidence is increasing in the general population, and multiple studies confirm that obesity is a risk factor associated with the development of RA,” Stefano Alivernini, MD, rheumatologist at Catholic University of the Sacred Heart in Rome, said in the press release. “We are interested in the analysis of fat-derived inflammation in systemic autoimmune diseases as RA, as well as the discovery of biomarkers to individualize and personalize treatment. Despite analysis of synovial inflammation in animal models of arthritis, no data are available on the synovial tissue analysis of such a population in humans.”
Alivernini and colleagues performed a synovial tissue biopsy on 125 patients with RA to determine the effect of BMI on synovial tissue inflammation from disease onset to stable remission. Participants were categorized according to BMI (normal: <25 kg/m2, overweight: >25 kg/m2 to 30 kg/m2 and obese: >30 kg/m2) and immunohistochemistry was performed for CD68+, CD21+, CD20+ and CD3+ cells. Treatment history among patients was as follows: 57 disease-modifying antirheumatic drugs-naïve; 43 methotrexate inadequate responder (MTX-IR); and 25 in stable clinical (DAS<1.6) and ultrasound remission under MTX and tumor necrosis factor-inhibitor therapy. Naïve patients were treated using the treat-to-target strategy and followed for 1 year, according to the abstract.
DMARD-naïve patients were younger than both the MTX-IR patients and those in remission. However, no other significant differences in the patients’ demographic, immunologic and clinical characteristics were reported.
Rates of overweight and obesity were comparable between the three patient groups: 59.6% of DMARD-naïve patients; 58.2% of MTX-IR patients; and 56% of patients in remission. However, signs of likely follicular synovitis occurred more often in treatment-naïve patients with obesity compared with those at normal weight (78.6% vs. 39.1%). In addition, compared with those at normal weight, patients in this group with BMI of greater than 35 kg/m2 showed greater histological scores for CD68+ lining and sublining, sublining CD20+, CD21+ lining and sublining, and sublining CD3+ cells, according to the press release.
Patients in the MTX-IR group also demonstrated similar degrees of synovial inflammation based on their BMI. At both 6- and 12-month follow up, treatment-naïve patients who were overweight or obese had worse clinical response to treat-to-target therapy compared with naïve patients with normal weight, regardless of their synovial inflammation pattern (follicular or diverse).
Disease activity index scores and inflammation markers (erythrocyte sedimentation rate and C-reactive protein) were lower among patients in the stable remission group compared with those who were treatment-naïve. However, patients with overweight or obese and in stable remission had greater degrees of residual synovial inflammation vs. those with normal weight, according to the release.
“Based on these results, we believe that it’s important to track patients’ BMI in clinical practice, since there is a tight relation between the BMI category of RA patients and their chance of a good clinical response to treat-to-target,” Alivernini said in the release. “Since body weight is a modifiable factor, a standardized, multidisciplinary approach to help the patient achieve weight loss should be advised to increase disease control.”
Reference:
Alivernini S, et al. Abstract 1898. Presented at the: American College of Rheumatology Annual Meeting; Nov. 4-8, 2017; San Diego.
Disclosures: The authors report no relevant financial disclosures.