Excess Weight Linked to Poor Rheumatoid Arthritis Outcomes

Alice Goodman

June 24, 2013

MADRID, Spain — Overweight patients with rheumatoid arthritis (RA) have more disease activity, lower rates of remission, and are twice as likely as patients with a healthy weight to require a tumor necrosis factor (TNF) inhibitor, according to a new study.

"Obesity and RA are both on the rise in many countries in the world, with devastating effects on individuals and society as a whole," said lead investigator Elisa Gremese, MD, from the Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, in Rome, Italy. "These data reinforce the link between obesity and inflammation, and establish that body mass index is one of the few modifiable factors that influence outcomes in RA."

Dr. Gremese presented the results here at the European League Against Rheumatism Congress 2013.

At baseline, 346 patients with early RA were stratified as normal weight (48.6%), overweight (39.0%), or obese (12.4%). Patients were treated using a treat-to-target strategy with the goal of remission with methotrexate plus or minus corticosteroids. A TNF inhibitor was added if a good response was not obtained.

At baseline, median disease activity score was 3.6. Obese patients had higher disease activity levels and functional disability on the Health Assessment Questionnaire than normal-weight patients.

At 12-month follow-up, remission rates were significantly higher in normal-weight patients than in obese patients (49.1% vs. 24.1%; = .08), and were also significantly higher in normal-weight patients than in overweight patients (49.1% vs. 28.7%; = .08). Clinical disease activity index remission rates at 12 months were 50.0% in normal-weight patients, 37.1% in overweight patients, and 31.0% in obese patients.

At 12 months, a TNF inhibitor for suboptimal response was required by 16.2% of normal-weight patients, 28.8% of overweight patients, and 28.1% of obese patients.

Obesity and Inflammation

As a result of these findings, a dedicated outpatient service for weight loss has been instituted at Dr. Gremese's institution for patients with RA and other rheumatic diseases. The program is multidisciplinary and is led by a dietician, in collaboration with a psychologist and a rheumatologist.

The study showed that cytokines and molecules implicated in inflammatory overload are weight-related. Dr. Gremese's team plans to study this relationship further. They also plan to look at whether weight loss in RA patients reduces disease activity and allows patients to continue methotrexate treatment with or without a corticosteroid without the need for a biologic.

"The study indicates that there may be a pathogenic basis for why obese patients have a poor response to therapy," said Maya Buch, MD, from the University of Leeds in the United Kingdom. "In clinical practice, it is important to encourage weight loss in patients with RA to reduce comorbidities. This study suggests that obese and overweight patients have less likelihood of remission than normal-weight patients, which is another reason to focus on weight loss."

Dr. Gremese and Dr. Buch have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2013. Abstract OP0178. Presented June 14, 2013.

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